nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2013-17-4-63-67nefr-470Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSФАКТОРЫ РИСКА И ИСХОДЫ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК У ПАЦИЕНТОВ С СОХРАННОЙ ФУНКЦИЕЙ ПОЧЕК, ПОДВЕРГНУТЫХ АОРТОКОРОНАРНОМУ ШУНТИРОВАНИЮRISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH INTACT RENAL FUNCTION UNDERGOING CORONARY ARTERY BYPASS GRAFTINGИскендеровБ. Г.IskenderovB. G.

Кафедра терапии, кардиологии и функциональной диагностики

440060, г. Пенза, ул. Стасова, д. 8, кв. 10. Тел.: 8 906 399 5672. Факс: 8 (8412) 96-45-44

iskenderovbg@mail.ruСисинаО. Н.SisinaO. N.

кафедра нефрологии

Пензенский институт усовершенствования врачейRussian Federation2013100420131746367Copyright © Искендеров Б.Г., Сисина О.Н., 20132013Искендеров Б.Г., Сисина О.Н.Iskenderov B.G., Sisina O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/470

ЦЕЛЬ ИССЛЕДОВАНИЯ: изучить частоту развития и факторы риска острого повреждения почек (ОПП), а также особенности его течения в послеоперационном периоде у пациентов, подвергнутых аортокоронарному шунтированию (АКШ). ПАЦИЕНТЫ И МЕТОДЫ. Обследовано 548 пациентов (331 мужчина и 217 женщин) в возрасте от 42 до 68 лет (средний возраст 57,9±8,3 года) до и после АКШ с применением искусственного кровообращения. Содержание сывороточного креатинина (sCr) и скорость клубочковой фильтрации (СКФ) определяли до АКШ, после операции ежедневно, перед выпиской домой и через 3 мес после. ОПП диагностировали и классифицировали по уровню sCr, используя критерии AKIN. РЕЗУЛЬТАТЫ. ОПП после АКШ было диагностировано у 132 пациентов (24,1%), из них у 109 пациентов (19,9%) была I стадия ОПП, у 64 пациентов (11,7%) – II стадия и у 29 пациентов (5,3%) – III стадия. У пациентов с ОПП послеоперационные осложнения диагностировались значительно чаще, чем у больных без ОПП. Почечная заместительная терапия (гемодиализ) проводилась у 7 пациентов (36,8%). Среди больных с ОПП госпитальная летальность составила 7,6%, а у пациентов без ОПП – 2,2% (χ2 = 7,23; p = 0,007). ЗАКЛЮЧЕНИЕ. Таким образом, уровни sCr у пациентов с ОПП наиболее тесно коррелировали с показателями, характеризующими тяжесть операции АКШ, а также такими коморбидными состояниями, как застойная сердечная недостаточность, артериальная гипертензия, фибрилляция предсердий и возраст выше 60 лет.

AIM: to study frequency and risk factors of AKI and also features of its clinical course in the postoperative period in patients undergoing CABG in a planned order. PATIENTS AND METHODS. 548 patients (331 men and 217 women) aged from 42 to 68 years (57,9±8,3 years) were examined before and after CABG by cardiopulmonary bypass. A serum creatinine (sCr) levels and glomerular filtration rate were defined before operation, daily within 7 days after CABG, at discharge from the hospital and in 3 months after discharge. AKI was diagnosed and classified by level of sCr using criteria of RIFLE. RESULTS. AKI was diagnosed in 132 patients (24,1%) after CABG, out of them 109 patients (19,9%) had mild AKI, 64 patients (11,7%) – moderate AKI and 29 patients (5,3%) – with severe AKI. Also transient AKI was revealed in 58,3% of the cases, persistent AKI – in 39,4% of the cases and resistant AKI – in 2,3% of the cases. Renal replacement therapy (hemodialysis) was performed in 7 patients (36,8%). An in-hospital mortality among patients with and without AKI was 7,6% and 2,2% respectively (χ2 = 7,23; p = 0,007). CONCLUSION. Thus, sCr levels in patients with AKI were associated with such factors as characteristics of severity of CABG surgery, comorbid conditions such as congestive heart failure, hypertension, atrial fibrillation and age higher than 60 years.

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The authors declare that there are no conflicts of interest present.