左心室辅助装置植入术后早期急性肾损伤：发生率、危险因素和临床后果。

Acute kidney injury early after left ventricular assist device implantation: incidence, risk factors and clinical consequences.

机构信息

Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey.

出版信息

Eur Rev Med Pharmacol Sci. 2023 Apr;27(8):3336-3343. doi: 10.26355/eurrev_202304_32104.

DOI:10.26355/eurrev_202304_32104

PMID:37140283

Abstract

OBJECTIVE

Renal dysfunction or renal failure is a common complication in patients undergoing a left ventricular assist device (LVAD). Measurement of serum creatinine and estimated glomerular filtration rate (eGFR) is the most commonly used inexpensive and easy method for the evaluation of kidney function. In studies, the development of acute kidney injury (AKI) after LVAD has generally been studied at 1, 3 months and 1 year, but there are almost no studies with 1-week data.

PATIENTS AND METHODS

We retrospectively analyzed the incidence of AKI, risk factors, length of stay in hospital and intensive care unit (ICU), and postoperative complications of 138 patients who underwent LVAD implantation in our center between 2012 and 2021, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the preoperative, postoperative 1st day, 2nd day, 1st week, 1st month, 3rd month and 1st year serum creatinine, eGFR and blood urea nitrogen (BUN) values.

RESULTS

The mean age of 138 patients who underwent LVAD implantation and evaluated the development of AKI was 50.4 (±10.86) and 119 (86.2%) were males. The incidence of AKI, the need for renal replacement therapy (RRT) and dialysis after LVAD implant were respectively 25.4%, 25.3% and 12.3%. According to the KDIGO criteria, in the AKI (+) patient group, 21 (15.2%) cases were identified as stage 1, 9 (6.5%) as stage 2 and 5 (3.6%) as stage 3. The incidence of AKI was found to be high in cases with diabetes mellitus (DM), age, preoperative creatinine level ≥1.2, and eGFR ≤60 ml/min/m2. There is a statistically significant relationship between having AKI and right ventricular (RV) failure (p=0.0033). Right ventricular failure developed in 10 (28.6%) of 35 patients who developed AKI.

CONCLUSIONS

If perioperative AKI is recognized early, the development of advanced stages of AKI and mortality can be reduced with nephroprotective measures.

摘要

目的

肾功能障碍或衰竭是接受左心室辅助装置（LVAD）治疗的患者常见的并发症。血清肌酐和估算肾小球滤过率（eGFR）的测量是评估肾功能最常用的廉价且简便的方法。在研究中，LVAD 后急性肾损伤（AKI）的发展通常在 1、3 个月和 1 年进行研究，但几乎没有 1 周数据的研究。

患者和方法

根据肾脏病改善全球结局（KDIGO）标准，我们回顾性分析了 2012 年至 2021 年间在我中心接受 LVAD 植入术的 138 例患者的 AKI 发生率、危险因素、住院和重症监护病房（ICU）时间以及术后并发症。我们评估了术前、术后第 1 天、第 2 天、第 1 周、第 1 个月、第 3 个月和第 1 年的血清肌酐、eGFR 和血尿素氮（BUN）值。

结果

接受 LVAD 植入术并评估 AKI 发展的 138 例患者的平均年龄为 50.4（±10.86）岁，119 例（86.2%）为男性。AKI 的发生率、LVAD 植入后需要肾脏替代治疗（RRT）和透析的分别为 25.4%、25.3%和 12.3%。根据 KDIGO 标准，在 AKI（+）患者组中，21 例（15.2%）为 1 期，9 例（6.5%）为 2 期，5 例（3.6%）为 3 期。糖尿病（DM）、年龄、术前肌酐水平≥1.2、eGFR≤60ml/min/m2 与 AKI 发生率较高有关。AKI 的发生与右心室（RV）衰竭之间存在显著关系（p=0.0033）。在发生 AKI 的 35 例患者中，有 10 例（28.6%）发生 RV 衰竭。