Fielding-Singh Vikram, Vanneman Matthew W, Hong Tracey, Sun Louise Y, Morris Arden M, Chertow Glenn M, Lin Eugene
Division of Cardiovascular and Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
Ann Thorac Surg Short Rep. 2024 Jul 1;2(4):877-883. doi: 10.1016/j.atssr.2024.06.017. eCollection 2024 Dec.
Contemporary population-based data examining the rates of cardiac surgery and the relationship between non-dialysis-requiring chronic kidney disease (CKD) and postoperative outcomes in cardiac surgery are limited.
We identified hospital admissions for cardiac surgical procedures in adults from 2010-2019 in the United States. The primary exposure was kidney disease, categorized as CKD stage G3, CKD stages G4 or G5, and end-stage kidney disease (ESKD). The primary outcome was in-hospital mortality. We evaluated the association between CKD stage and in-hospital-mortality by using multivariable logistic regression. We calculated the annual national incidence of cardiac surgical procedures by CKD stage by incorporating data from the United States Census Bureau.
We identified an estimated 2,772,081 admissions during which patients aged 18 years or older underwent cardiac surgical procedures. The incidence of cardiac surgical procedures was 1.1, 1.0, and 13.0 per 1000 person-years among patients with normal or nearly normal kidney function, non-dialysis-requiring kidney disease, and ESKD, respectively. In-hospital mortality was 2.2%, 3.7%, 6.7%, and 8.8% among patients with normal or nearly normal kidney function, CKD stage G3, CKD stages G4 or G5, and ESKD, respectively. In adjusted analyses, patients with CKD stage G3, CKD stage G4 or G5, and ESKD experienced absolute risks of in-hospital mortality that were 0.6% (95% CI, 0.5%-0.7%), 2.2% (95% CI, 1.8%-2.6%), and 4.4% (95% CI, 4.0%-4.8%) higher, respectively, than in patients with normal or nearly normal kidney function.
In the United States, advanced stages of CKD are associated with an increased incidence of cardiac surgical procedures, as well as high adjusted risks of in-hospital mortality.
基于当代人群的数据，研究心脏手术的发生率以及无需透析的慢性肾脏病（CKD）与心脏手术后结局之间的关系，此类数据有限。
我们确定了2010年至2019年美国成人心脏外科手术的住院情况。主要暴露因素为肾脏疾病，分为CKD G3期、CKD G4或G5期以及终末期肾病（ESKD）。主要结局为住院死亡率。我们使用多变量逻辑回归评估CKD分期与住院死亡率之间的关联。通过纳入美国人口普查局的数据，我们计算了按CKD分期划分的心脏外科手术的年度全国发病率。
我们确定了约2,772,081例住院病例，其中18岁及以上的患者接受了心脏外科手术。肾功能正常或接近正常的患者、无需透析的肾脏疾病患者和ESKD患者的心脏外科手术发病率分别为每1000人年1.1、1.0和13.0例。肾功能正常或接近正常的患者、CKD G3期患者、CKD G4或G5期患者以及ESKD患者的住院死亡率分别为2.2%、3.7%、6.7%和8.8%。在调整分析中，CKD G3期、CKD G4或G5期以及ESKD患者的住院死亡绝对风险分别比肾功能正常或接近正常的患者高0.6%（95%CI，0.5%-0.7%）、2.2%（95%CI，1.8%-2.6%）和4.4%（95%CI，4.0%-4.8%）。
在美国，CKD晚期与心脏外科手术发病率增加以及住院死亡的调整后高风险相关。
