Effects of chronic kidney disease and post-angiographic acute kidney injury on long-term prognosis after coronary artery angiography
Effects of chronic kidney disease and post-angiographic acute kidney injury on long-term prognosis after coronary artery angiography
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DOI：
10.1093/ndt/gfq631
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发表时间：
2011-06-01
影响因子：
6.1
通讯作者：
Hayashi, Terumasa
中科院分区：
文献类型：
--
作者：
Kimura, Tomonori;Obi, Yoshitsugu;Hayashi, Terumasa
背景慢性肾脏疾病（CKD）和血管造影后急性肾损伤（阿基）被认为是冠状动脉造影后长期死亡的危险因素。另一方面，需要血液动力学支持的急性血液动力学紊乱对阿基的发生率和冠状动脉造影术后的预后有很大影响。本研究的目的是确定CKD和阿基对住院幸存者冠状动脉造影术后长期预后的影响，并确定与血流动力学变量的关系。我们研究了2439例接受冠状动脉造影或经皮冠状动脉介入治疗的患者。使用病例组合和实验室变量的未校正和校正考克斯模型测量CKD和阿基与死亡率或心血管疾病之间的关系。多变量考克斯回归分析确定CKD是长期死亡率[校正风险比（AHR）1.51; 95%置信区间（95% CI）1.07-2.13]和复合终点（AHR 1.72; 95% CI 1.40-2.11）的独立预测因子。低于50 mL/min/1.73 m（2）的较低估计肾小球滤过率水平与调整后的死亡率显着相关。即使在血流动力学稳定的患者中也发现了类似的相关性。阿基也是长期复合终点的预测因子（AHR 1.64; 95%CI 1.09-2.46）;然而，在血流动力学稳定的患者中，其影响减弱。在住院存活者中，CKD是长期死亡率和复合终点的独立预测因子，与血流动力学条件无关。阿基也是长期预后的预测因子;然而，在血流动力学稳定的住院幸存者中，其影响可能会减弱。
Background. Both chronic kidney disease (CKD) and post-angiographic acute kidney injury (AKI) are regarded as risks factors for long-term mortality after coronary angiography. On the other hand, acute haemodynamic disturbances requiring haemodynamic support have a strong impact on both the incidence of AKI and on prognosis after coronary angiography. The aim of this study was to determine the impact of CKD and AKI on long-term prognosis after coronary angiography among hospital survivors and to determine relationships with haemodynamic variables.Methods. We studied 2439 patients who underwent coronary angiography or percutaneous coronary intervention. Relationships between both CKD and AKI and mortality or cardiovascular diseases were measured using unadjusted and adjusted Cox models for case-mix and laboratory variables.Results. Multivariable Cox regression analysis identified CKD as an independent predictor of long-term mortality [ adjusted hazard ratio (AHR) 1.51; 95% confidence interval (95% CI) 1.07-2.13] and composite end points (AHR 1.72; 95% CI 1.40-2.11). Lower estimated glomerular filtration ratio levels below 50 mL/min/1.73 m(2) were significantly associated with mortality after adjustments. A similar association was found even in haemodynamically stable patients. AKI was also a predictor of long-term composite end points (AHR 1.64; 95% CI 1.09-2.46); however, its impact was attenuated in haemodynamically stable patients.Conclusions. Among hospital survivors, CKD is an independent predictor for both long-term mortality and composite end points, regardless of haemodynamic conditions. AKI is also a predictor of long-term prognosis; however, its impact may be attenuated in haemodynamically stable hospital survivors.