Acute kidney injury following cardiac surgery: current understanding and future directions.
Acute kidney injury following cardiac surgery: current understanding and future directions.
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DOI：
10.1186/s13054-016-1352-z
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发表时间：
2016-07-04
期刊：
影响因子：
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通讯作者：
Billings FT 4th
中科院分区：
文献类型：
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作者：
O'Neal JB;Shaw AD;Billings FT 4th
急性肾损伤（阿基）使多达30%的患者的心脏手术恢复复杂化，损伤和损害脑、肺和肠道的功能，并使患者在住院期间的死亡风险增加5倍。肾缺血、再灌注、炎症、溶血、氧化应激、胆固醇栓塞和毒素有助于阿基的发生和进展。预防策略有限，但目前的证据支持维持肾脏灌注和血管内容量，同时避免静脉充血，给予平衡盐而不是高氯化物静脉输液，以及避免或限制心肺转流暴露。需要肾脏替代治疗的阿基发生在2- 5%的心脏手术后患者中，并与50%的死亡率相关。对于那些从肾脏替代治疗中恢复或甚至轻度阿基的患者，在随后的数月和数年内进展为慢性肾脏疾病的可能性比那些未发生阿基的患者更大。心脏手术仍然是一种流行的临床模型，用于评价阿基的新型治疗方法、现有药物的标签外使用和非药物治疗，因为心脏手术相当常见，通常是择期手术，提供相对标准化的损伤，患者在手术后仍需住院并接受监测。更有效和时间敏感的诊断阿基的方法对于减少这种负面结果至关重要。肾损伤生物标志物的发现和验证应及时取代基于肌酐的阿基临床诊断标准。
Acute kidney injury (AKI) complicates recovery from cardiac surgery in up to 30 % of patients, injures and impairs the function of the brain, lungs, and gut, and places patients at a 5-fold increased risk of death during hospitalization. Renal ischemia, reperfusion, inflammation, hemolysis, oxidative stress, cholesterol emboli, and toxins contribute to the development and progression of AKI. Preventive strategies are limited, but current evidence supports maintenance of renal perfusion and intravascular volume while avoiding venous congestion, administration of balanced salt as opposed to high-chloride intravenous fluids, and the avoidance or limitation of cardiopulmonary bypass exposure. AKI that requires renal replacement therapy occurs in 2–5 % of patients following cardiac surgery and is associated with 50 % mortality. For those who recover from renal replacement therapy or even mild AKI, progression to chronic kidney disease in the ensuing months and years is more likely than for those who do not develop AKI. Cardiac surgery continues to be a popular clinical model to evaluate novel therapeutics, off-label use of existing medications, and nonpharmacologic treatments for AKI, since cardiac surgery is fairly common, typically elective, provides a relatively standardized insult, and patients remain hospitalized and monitored following surgery. More efficient and time-sensitive methods to diagnose AKI are imperative to reduce this negative outcome. The discovery and validation of renal damage biomarkers should in time supplant creatinine-based criteria for the clinical diagnosis of AKI.