nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-536Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВыбор модальности заместительной почечной терапии в кардиохирургии на основе прогноза неблагоприятного исходаThe choice of the modality of the renal replacement therapy after cardiac surgery based on the prognosis of poor outcomeМаловА. А.MalovA. A.malov1967@gmail.comМухоедоваТ. В.MukhoedovaT. V.noemail@neicon.ruБорисовА. С.BorisovA. S.noemail@neicon.ruФГБУ «ННИИПК им. акад. Е.Н. Мешалкина» Минздрава РоссииРоссияState Research Institute of Circulation Pathology Novosibirsk, Russian FederationRussian Federation201413092024161155161Copyright © Малов А.А., Мухоедова Т.В., Борисов А.С., 20242024Малов А.А., Мухоедова Т.В., Борисов А.С.Malov A.A., Mukhoedova T.V., Borisov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/536

Цель исследования: разработка критерия выбора модальности заместительной почечной терапии (ЗПТ) при диализ-зависимом остром почечном повреждении (ОПП) после кардиохирургических вмешательств с искусственным кровообращением (ИК). Материалы и методы. Было проведено одноцентровое ретроспективное когортное исследование, оценивающее потенциальные демографические и клинические факторы риска неблагоприятного исхода у пациентов с диализ-зависимым острым почечным повреждением после кардиохирургических вмешательств с ИК. Разработана оригинальная прогностическая шкала, и на ее основе определен критерий выбора ЗПТ. Результаты. Разработанная шкала имеет лучшую прогностическую способность, чем шкалы, используемые в клинической практике. Величина площади под ROC-кривой (AUC) составила 0,892 (95% ДИ 0,852-0,925). Проведено сравнение прогностической способности разработанной шкалы и ряда широко используемых в клинической практике шкал. С использованием новой шкалы был разработан критерий выбора модальности ЗПТ у исследуемой группы пациентов. Величина балльной оценки для новой шкалы 3,2 признана безопасной границей выбора между интермиттирующей и постоянной ЗПТ. Заключение. Разработанная шкала является состоятельной в прогнозе летальных исходов при диализ-зависимом ОПП после кардиохирургических вмешательств с ИК. Разработанная шкала и определенный с ее помощью критерий выбора модальности носят рекомендательный характер, как и любые другие прогностические шкалы.

The aim. Identification of the criteria for choice of the modality of renal replacement therapy (RRT) after cardiac surgery with cardiopulmonary bypass (CPB). Materials and methods. A single-center retrospective cohort study was performed to evaluate some demographic and clinical parameters as the potential risk factors for poor outcome in patients with AKI requiring RRT (AKI-D) after cardiac surgery with CPB. Original severity score was developed and a criterion was made for choice of renal replacement therapy modality. Results. Developed score had the best discriminatory ability for death predicting in patients with AKI-D after cardiac surgery with CPB. The area under the receiver operating characteristic (ROC) curve for the score was 0,892 (95% CI 0,852 to 0,925). Its predictive accuracy was compared with other scores by area under the ROC curve. After applying the new score to the group of patients on intermittent hemodialysis (IHD) a defined criterion for the choice of RRT modality was developed. The value of the new score of 3,2 and below was found to be safe for the choice of intermittent hemodialysis modality. Conclusions. The new score is valid and accurate in predicting death for AKI-D after open-heart surgery. This score and value for the choice of RRT was made for guidance only, but in difficult situations, this score can facilitate the choice.

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