nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2018-22-4-96-101nefr-522Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSРАСПРОСТРАНЕННОСТЬ, ФАКТОРЫ РИСКА И ИСХОДЫ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК В РАННЕМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯFREQUENCY RISK FACTORS AND OUTCOMES ACUTE KIDNEY INJURY IN THE EARLY PERIOD IN PATIENTS WITH CHRONIC KIDNEY DISEASE AFTER CABG SURGERYhttps://orcid.org/0000-0001-6089-9722БазылевВ. В.BazylevV. V.

440071, Россия, Пензенская область, г. Пенза, ул. Стасова, д. 6

Проф. Базылев Владлен Владленович, д-р мед. наук, главный врач. Тел./факс: (8412)41-23-11, (8412)41-23-77

440071 Russian Federation Penza, Stasova St. 6

Prof. Vladlen V. Bazylev MD, DMedSci, Chief Medical Offi cer. Phone /fax (8412)41-23-11, (8412)41-23-77

cardio-penza@yandex.ruhttps://orcid.org/0000-0002-4477-0037ГорностаевА. А.GornostaevA. A.

440071, Россия, Пензенская область, г. Пенза, ул. Стасова, д. 6

Горностаев Александр Александрович заведующий отделением анестезиологии и  реанимации № 2. Тел./факс: (8412)41-23-11, (8412)41-23-77, Моб. +7 927 375-05-69

440071 Russian Federation Penza, Stasova St. 6

Aleksander A. Gornostaev, MD, Chief of Anesthesiology and Intensive Care Unit №2, Phone /fax (8412)41-23-11, (8412)41-23-77

aagornostaev@yandex.ruhttps://orcid.org/0000-0001-7463-7731ЩегольковА. А.Schegol’kovA. A.

440071, Россия, Пензенская область, г. Пенза, ул. Стасова, д. 6

Щегольков Алексей Александрович врач отделения анестезиологии и реанимации № 2. Тел./факс: (8412)41-23-11, (8412)41-23-77, Моб. +7 927 388-93-55

440071 Russian Federation Penza, Stasova St. 6

Aleksey A. Schegolkov, MD, Critical care physician of Anesthesiology and Intensive Care Unit №2. Phone /fax (8412)41-23-11, (8412)41-23-77

shchegolkov@gmail.comhttps://orcid.org/0000-0002-8360-2722БулыгинА. В.BulyginA. V.

440071, Россия, Пензенская область, г. Пенза, ул. Стасова, д. 6

Булыгин Алексей Владимирович врач отделения анестезиологии и реанимации № 2. Тел./факс: (8412)41-23-11, (8412)41-23-77, Моб. +7 927 378-68-09

440071 Russian Federation Penza, Stasova St. 6

Aleksey V. Bulygin, Critical care physician of Anesthesiology and Intensive Care Unit №2. Phone /fax (8412)41-23-11, (8412)41-23-77

anesthar@gmail.comФедеральный центр сердечно-сосудистой хирургии Министерства здравоохранения РоссииРоссияFederal Center for Cardiovascular Surgery, Ministry of Health Care of Russian FederationRussian Federation20182107201822496101Copyright © Базылев В.В., Горностаев А.А., Щегольков А.А., Булыгин А.В., 20182018Базылев В.В., Горностаев А.А., Щегольков А.А., Булыгин А.В.Bazylev V.V., Gornostaev A.A., Schegol’kov A.A., Bulygin A.V.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/522ЦЕЛЬ

ЦЕЛЬ: оценить факторы риска и распространенность острого повреждения почек (ОПП) у пациентов с хронической болезнью почек (ХБП) после изолированного коронарного  шунтирования (КШ) в раннем послеоперационном периоде.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. В исследование включены 830 пациентов с изолированным КШ. Все операции выполнены в 2016 году. Для оценки функции почек в предоперационном  периоде рассчитывали скорость клубочковой фильтрации (СКФ) по формуле Chronic Kidney  Disease Epidemiology Collaboration (CKD-EPI). ОПП диагностировали в соответствии с  критериями Kidney Disease: Improving Global Outcomes (KDIGO). Пациенты  стратифицированы в группы в зависимости от величины СКФ.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Частота развития ОПП в группе пациентов без ХБП в анамнезе после КШ  составила 11,5% (n=59), в группе ОПП, осложняющего течение ХБП (ОПП–ХБП), 12,3%  (n=39). При наличии в анамнезе у пациента ХБП и проведении интраоперационно  инотропной/вазопрессорной терапии, используя два лекарственных препарата этой группы  и более, вероятность развития ОПП возрастает в 11,16 раза (OR 11,46; 95% CI 3,47–37,83;  р<0,01). При снижении гематокрита во время искусственного кровообращения (ИК) на 1%  вероятность развития ОПП возрастает на 12,36% (OR 0,89; 95% CI 0,81–0,98; р=0,02).  Необходимость проведения сеансов гемодиализа, длительность пребывания в отделении  интенсивной терапии и длительность госпитализации между группами не различались.  Развитие ОПП–ХБП достоверно увеличивает внтуригоспитальную летальность (р<0,05).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Наличие в анамнезе ХБП увеличивает вероятность тяжелого течения ОПП, а также летальность в раннем послеоперационном периоде. Выявленные факторы риска развития ОПП являются потенциально модифицируемыми.

AIM

AIM: To evaluate risk factors and prevalence of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) in the early period after isolated coronary artery bypass graft (CABG).

PATIENTS AND METHODS

PATIENTS AND METHODS: The study included 830 patients with  isolated CABG. All surgeries were performed in 2016. To evaluate  kidney function in preoperative period glomerular filtration rate  (GFR) was estimated by Chronic Kidney Disease Epidemiology  Collaboration (CKD-EPI) formula. AKI was diagnosed according to  KDIGO criteria. Patients were stratified into two groups according to  estimated glomerular filtration rate (eGFR).

RESULTS

RESULTS: The prevalence of AKI in patients group without CKD after CABG was 11,5% (n=59), in CKD-AKI group – 12,3% (n=39).  In patients with CKD and after intraoperative inotropic/vasopressor  therapy use of only 2 medicinal drugs of this group the probability of  AKI development increases 11,16 times (OR 11,46; 95% CI 3,47- 37,83; р<0,01). During complete bypass (CB) when haematocrit  decreases on 1% AKI probability increases on 12,36% (OR 0,89; 95% CI 0,81-0,98; р=0,02). The necessity of haemodialisys,  duration of stay in intensive care unit and hospitalization duration  were equal to all groups. AKI-CKD development significantly increases intrahospital mortality (p<0,05). 

CONCLUSIONS

CONCLUSIONS: History of CKD increases probability of severe AKI and also mortality in early postoperative period. Revealed risk factors for AKI development are potentially modifiable.

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