Prognostic value of the chronic kidney disease in the patients undergoing correction of valve heart disease
Abstract
Aim: to determine short- and long-term postoperative prognosis in patients with chronic kidney disease (CKD) undergoing correction of valve heart disease depend on evolvement of acute kidney injury (AKI). Patients and methods. 647 patients (298 men and 349 women) aged from 34 till 67 years (average 52,7 ± 7,3 years) were examined whom the correction of valvular heart disease with cardiopulmonary bypass was performed. In 306 patients GFR decreased from 89 to 45 mL/min/1,73 m2 (1st group), but in 341 patients GFR was greater than 90 mL/min/1,73 m2 (2nd group). AKI was diagnosed and classified according to RIFLE-criteria by the change in serum creatinine (sCr). Results. The incidence of early postoperative complications (myocardial infarction, stroke, acute heart failure, paroxysmal tachiarrhythmias, sepsis, respiratory distress) was significantly higher in the 1st group than in the 2nd group. In the first days after operations AKI has developed in 157 patients (51,3%) in the 1st group and in 103 patients (30,2%) in the 2nd group (p < 0,001). Renal replacement therapy (hemodialysis) was performed more frequently in the 1st group (p = 0,003), and in-hospital mortality was also higher in the 1st group (p < 0,001) than in the 2nd group. Conclusion. It was shown that the presence of CKD in patients undergoing correction of valve heart disease and complicated with AKI has adverse influence on short-term postoperative prognosis and long-term prognosis is even better in 46,5% of them.
About the Authors
B. G. Iskenderov
Penza Institute of Postgraduate Medical Training
Russian Federation
Russian Federation
O. N. Sisina
Penza Institute of Postgraduate Medical Training
Russian Federation
Russian Federation
Z. M. Budagovskaya
Penza city clinical Emergency Hospital, Penza
Russian Federation
Russian Federation
References
1. Гарсиа-Донаире Ж.А., Руилопе Л.М. Кардио-васкулярно-ренальные связи в кардиоренальном континууме // Нефрология. 2013. Т. 17. № 1. С. 11-41.
2. Искендеров Б.Г., Сисина О.Н. Факторы риска и исходы острого повреждения почек у пациентов с сохранной функцией почек, подвергнутых аортокоронарному шунтированию // Нефрология. 2013. Т. 17. № 4. С. 63-67.
3. Шилов Е.Н., Фомин В.В., Швецов М.Ю. Хроническая болезнь почек // Тер. архив. 2007. Т. № 6. С. 75-78.
4. Akcay A., Turkmen K., Lee D., Edelstein C. Update on the diagnosis and management of acute kidney injury // Int. J. Nephrol. Renovasc. Dis. 2010. Vol. 3. P. 129-140.
5. Bagur R., Webb J.G., Nietlispach F. et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement // Eur. Heart J. 2010. Vol. 31. № 7. P. 865-874.
6. Bellomo R., Kellum J.A., Ronco C. Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria // Intensive Care Med. 2007. Vol. 33 (3). P. 409-413.
7. Go A.S., Chertow G.M., Fan D. et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization // N. Engl. J. Med. 2004. Vol. 351. P. 1296-1305.
8. Grams M.E., Astor B.C., Bash L.D. et al. Albuminuria and estimated glomerular filtration rate independently associate with acute kidney injury // J. Am. Soc. Nephrol. 2010. Vol. 21. P. 1757-1764.
9. Hobson C.E., Yavas S., Segal M.S. et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery // Circulation. 2009. Vol. 119. P. 2444-2453.
10. Huang T.M., Wu V.C., Young G.H. et al. Preoperative proteinuria predicts adverse renal outcomes after coronary artery bypass grafting // J. Am. Soc. Nephrol. 2011. Vol. 22. P. 156-163.
11. Hsu C.Y., Ordonez J.D., Chertow G.M. et al. The risk of acute renal failure in patients with chronic kidney disease // Kidney Int. 2008. Vol. 74. P. 101-107.
12. James M.T., Hemmelgarn B.R., Wiebe N. et al. Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study // Lancet. 2010. Vol. 376. P. 2096-2103.
13. Khosla N., Soroko S.B., Chertow G.M. et al. Preexisting chronic kidney disease: a potential for improved outcomes from acute kidney injury // Clin. J. Am. Soc. Nephrol. 2009. Vol. 4. P. 1914-1919.
14. Landoni G., Zangrillo A., Franco A. et al. Long-term outcome of patients who require renal replacement therapy after cardiac surgery // Eur. J. Anaesthesiol. 2006. Vol. 23 (1). P. 17-22.
15. Levey A.S., Greene T., Kusek J. et al. MDRD Study Group: A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract] // J. Am. Soc. Nephrol. 2000. Vol. 11. P. A0828.
16. Levey A.S., Eckardt K.U., Tsukamoto Y. et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO) // Kidney Int. 2005. Vol. 67. P. 2089-2100.
17. Lombardi R., Ferreiro A. Risk factors profile for acute kidney injury after cardiac surgery is different according to the level of baseline renal function // Ren. Fail. 2008. Vol. 30. P. 155-160.
18. Singh P., Rifkin D.E., Blantz R.C. Chronic kidney disease: an inherent risk factor for acute kidney injury? // Clin. J. Am. Soc. Nephrol. 2010. Vol. 5. P. 1690-1695.
19. Spini V., Cecchi E., Chiostr M. et al. Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal dysfunction submitted to coronary invasive procedures // J. Iinvasive Cardiol. 2013. Vol. 25 (2). P. 80-84.
20. Waikar S.S., Liu K.D., Chertow G.M. Diagnosis, epidemiology, and outcomes of acute renal failure // Clin. J. Am. Soc. Nephrol. 2008. Vol. 3 (3). P. 844-861.
21. Wessely M., Rau S., Lange Ph. et al. Chronic kidney disease is not associated with a higher risk for mortality or acute kidney injury in transcatheter aortic valve implantation // Nephrology Dialysis Transplantation. 2012. Vol. 27 (9). P. 3502-3508.
22. Worley S., Arrigain S., Yared J.P., Paganini E.P. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function // Kidney Int. 2005. Vol. 67. P. 1112-1119.
Review
For citations:
Iskenderov B.G., Sisina O.N., Budagovskaya Z.M. Prognostic value of the chronic kidney disease in the patients undergoing correction of valve heart disease. Nephrology and Dialysis. 2014;16(1):144-150. (In Russ.)
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