Preoperative Proteinuria Predicts Adverse Renal Outcomes after Coronary Artery Bypass Grafting
Preoperative Proteinuria Predicts Adverse Renal Outcomes after Coronary Artery Bypass Grafting
复制标题
DOI：
10.1681/asn.2010050553
复制
发表时间：
2011-01-01
影响因子：
13.6
通讯作者：
Wu, Kwan-Dun
中科院分区：
文献类型：
--
作者：
Huang, Tao-Min;Wu, Vin-Cent;Wu, Kwan-Dun
术前蛋白尿是否与心脏手术后不良肾脏结局相关尚不清楚。在这里，我们对 2003 年至 2007 年间在一家医疗中心及其两家附属医院接受冠状动脉旁路移植术 (CABG) 的前瞻性入组成年患者进行了二次分析。我们排除了 5 期 CKD 或之前接受过透析的患者。我们将用试纸测量的蛋白尿定义为轻度（微量至 1+）或重度（2+ 至 4+）。在总共 1052 名患者中，183 名 (17.4%) 患者出现心脏手术相关急性肾损伤 (CSA-AKI)，50 名 (4.8%) 患者需要肾脏替代治疗 (RRT)。在多重 Logistic 回归模型中，轻度和重度蛋白尿均与 CSA-AKI 几率增加相关，与 CKD 分期和是否存在糖尿病无关（轻度：OR 1.66，95% CI 1.09 至 2.52；重度：OR 2.30，95% CI 1.35 至 3.90）。大量蛋白尿还与术后 RRT 几率增加相关（OR 7.29，95% CI 3.00 至 17.73）。总之，这些数据表明术前蛋白尿是接受 CABG 的患者 CSA-AKI 的预测因子。
Whether preoperative proteinuria associates with adverse renal outcomes after cardiac surgery is unknown. Here, we performed a secondary analysis of a prospectively enrolled cohort of adult patients undergoing coronary artery bypass grafting (CABG) at a medical center and its two affiliate hospitals between 2003 and 2007. We excluded patients with stage 5 CKD or those who received dialysis previously. We defined proteinuria, measured with a dipstick, as mild (trace to 1+) or heavy (2+ to 4+). Among a total of 1052 patients, cardiac surgery-associated acute kidney injury (CSA-AKI) developed in 183 (17.4%) patients and required renal replacement therapy (RRT) in 50 (4.8%) patients. In a multiple logistic regression model, mild and heavy proteinuria each associated with an increased odds of CSA-AKI, independent of CKD stage and the presence of diabetes mellitus (mild: OR 1.66, 95% CI 1.09 to 2.52; heavy: OR 2.30, 95% CI 1.35 to 3.90). Heavy proteinuria also associated with increased odds of postoperative RRT (OR 7.29, 95% CI 3.00 to 17.73). In summary, these data suggest that preoperative proteinuria is a predictor of CSA-AKI among patients undergoing CABG.