Acute Kidney Injury After Cardiac Surgery Focus on Modifiable Risk Factors

被引：552

作者：

Karkouti, Keyvan ^{[15
,16
]}

Wijeysundera, Duminda N. ^{[16
]}

Yau, Terrence M. ^{[14
]}

Callum, Jeannie L. ^{[13
]}

Cheng, Davy C. ^{[12
]}

Crowther, Mark ^{[11
]}

Dupuis, Jean-Yves ^{[10
]}

Fremes, Stephen E. ^{[9
]}

Kent, Blaine ^{[8
]}

Laflamme, Claude ^{[7
]}

Lamy, Andre ^{[6
]}

Legare, Jean-Francois ^{[5
]}

Mazer, C. David ^{[3
,4
]}

McCluskey, Stuart A. ^{[16
]}

Rubens, Fraser D. ^{[2
]}

Sawchuk, Corey ^{[1
]}

Beattie, W. Scott ^{[16
]}

机构：

[1] McMaster Univ, Dept Anesthesia, Hamilton, ON L8S 4L8, Canada

[2] Univ Ottawa, Dept Surg, Div Cardiac Surg, Ottawa, ON, Canada

[3] Univ Toronto, St Michaels Hosp, Dept Anesthesia, Keenan Res Ctr Li Ka Shing Knowledge Inst, Toronto, ON M5G 2C4, Canada

[4] Univ Toronto, St Michaels Hosp, Dept Crit Care, Keenan Res Ctr Li Ka Shing Knowledge Inst, Toronto, ON M5G 2C4, Canada

[5] Dalhousie Univ, Dept Surg, Div Cardiac Surg, Halifax, NS B3H 4H2, Canada

[6] McMaster Univ, Dept Surg, Div Cardiac Surg, Hamilton, ON L8S 4L8, Canada

[7] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Anesthesia, Toronto, ON M5G 2C4, Canada

[8] Dalhousie Univ, Dept Anesthesia, Halifax, NS B3H 4H2, Canada

[9] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Surg, Div Cardiac & Vasc Surg, Toronto, ON M5G 2C4, Canada

[10] Univ Ottawa, Dept Anesthesia, Ottawa, ON, Canada

[11] McMaster Univ, Dept Med, Div Hematol, Hamilton, ON L8S 4L8, Canada

[12] Univ Western Ontario, Dept Anesthesia, London, ON, Canada

[13] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Clin Pathol, Toronto, ON M5G 2C4, Canada

[14] Univ Toronto, Univ Hlth Network, Toronto Gen Hosp, Dept Surg,Div Cardiac Surg, Toronto, ON M5G 2C4, Canada

[15] Univ Toronto, Dept Hlth Policy Management & Evaluat, Toronto, ON M5G 2C4, Canada

[16] Univ Toronto, Univ Hlth Network, Toronto Gen Hosp, Dept Anesthesia, Toronto, ON M5G 2C4, Canada

来源：

CIRCULATION | 2009年 / 119卷 / 04期

基金：

加拿大健康研究院;

关键词：

surgery; cardiopulmonary bypass; kidney; risk factors; ACUTE-RENAL-FAILURE; RED-CELL STORAGE; ADVERSE OUTCOMES; CARDIOPULMONARY BYPASS; CREATININE CLEARANCE; PREOPERATIVE ANEMIA; BLOOD-CELLS; TRANSFUSION; DYSFUNCTION; VALIDATION;

D O I：

10.1161/CIRCULATIONAHA.108.786913

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Acute kidney injury (AKI) after cardiac surgery is a major health issue. Lacking effective therapies, risk factor modification may offer a means of preventing this complication. The objective of the present study was to identify and determine the prognostic importance of such risk factors. Methods and Results-Data from a multicenter cohort of 3500 adult patients who underwent cardiac surgery at 7 hospitals during 2004 were analyzed (using multivariable logistic regression modeling) to determine the independent relationships between 3 thresholds of AKI ( > 25%, > 50%, and > 75% decrease in estimated glomerular filtration rate within 1 week of surgery or need for postoperative dialysis) with death rates, as well as to identify modifiable risk factors for AKI. The 3 thresholds of AKI occurred in 24% (n=829), 7% (n=228), and 3% (n=119) of the cohort, respectively. All 3 thresholds were independently associated with a > 4-fold increase in the odds of death and could be predicted with several perioperative variables, including preoperative intra-aortic balloon pump use, urgent surgery, and prolonged cardiopulmonary bypass. In particular, 3 potentially modifiable variables were also independently and strongly associated with AKI. These were preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration. Conclusions-AKI after cardiac surgery is highly prevalent and prognostically important. Therapies aimed at mitigating preoperative anemia, perioperative red blood cell transfusions, and surgical reexploration may offer protection against this complication. (Circulation. 2009;119:495-502.)

引用

页码：495 / 502

页数：8

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[1] Current concepts - Normotensive ischemic acute renal failure [J].