Long-term Prognosis of Acute Kidney Injury in Cardiac Surgery

心脏手术中急性肾损伤的长期预后

• 批准号: 8277974
• 负责人: Steven G Coca
• 金额: $ 19.42万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8277974
• 关键词: Acute; Acute Renal Failure with Renal Papillary Necrosis; Adult; Affect; Area; Back; Biological Markers; Cardiac; Cardiac Surgery procedures; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Clinical; Coca; Coronary Artery Bypass; Creatinine; Detection; Development; Dialysis procedure; Disease; End stage renal failure; Excretory function; Failure; Functional disorder; Future; Glomerular Filtration Rate; Goals; Grant; Health Expenditures; Health Technology; Healthcare Systems; High Prevalence; Hospitalization; Hospitals; Hypertension; Incidence; Inflammatory; Interleukin-18; K-Series Research Career Programs; Kidney; Lead; Length; Modeling; Morbidity - disease rate; Myocardial Infarction; Operative Surgical Procedures; Outcome; Pathway interactions; Patient Care; Patients; Phase; Physicians; Population; Prevalence; Proteins; Proteinuria; Research Personnel; Residual state; Risk; Risk Assessment; Risk Factors; Sample Size; Serum; Severities; Signal Pathway; Stratification; Structure; Survivors; Time; Troponin; United States; cardiovascular disorder risk; cohort; design; falls; follow-up; hazard; improved; mortality; novel; outcome forecast; prevent; prognostic; programs; prospective; urinary; vigilance

It is well known that acute kidney injury (AKI) has a marked impact on clinical outcomes, including short-term mortality. Futhermore, the incidence of AKI has increased over the past several years. At the same time, the prevalence of chronic kidney disease is high and results in a major burden for patients and for the health care system in the United States. It is unclear if AKI is a completely reversible disease, or whether it leads to permanent kidney damage and thus CKD and death. This proposal will utilize a prospective cohort design that will add a long-term follow-up component to an ongoing multi-center 5-day study of urinary biomarkers for the detection of AKI after cardiac surgery. We will longitudinally study the patients with AKI as defined by at least a 25% increase in peri-operative serum creatinine and an equal number of patients without AKI that survive cardiac surgery at three academic centers. We will determine if AKI results in an increase in the decline in glomerular filtration rate and in increase in the protein excretion rate over time. We will compare the incidence of doubling of serum creatinine, dialysis or death in patients with and without AKI. In addition, we will examine if newly discovered biomarkers of acute kidney injury (urinary IL-18 and NGAL) are associated with CKD and death. As troponin has shown tremendous value in the setting of myocardial infarction, our hope is that these urinary biomarkers will possess long-term prognostic value for patients with AKI. Currently, AKI is viewed by most physicians as a reversible phenomenon that has little consequence after the acute phase. If, however, AKI is truly associated with long-term morbidity and mortality, then post-AKI care of these patients should involve closer vigilance and more aggressive treatments in order to improve long-term outcomes. My hope is to obtain R01 grants in the future with the goal of improving risk- stratification of AKI and I also hope to participate in multi-center trials of therapies for AKI and its associated complications.

众所周知，急性肾损伤（AKI）对临床结果具有显著影响，包括短期肾损伤。 mortality.然而，AKI的发病率在过去几年中有所增加。同时对 慢性肾脏疾病的患病率很高，并给患者和健康造成重大负担 美国的医疗系统。目前还不清楚AKI是否是一种完全可逆的疾病，或者它是否会导致 永久性肾损伤，从而导致CKD和死亡。 该提案将采用前瞻性队列设计，将长期随访部分添加到 正在进行的用于检测心脏手术后AKI的尿生物标志物的多中心5天研究。我们将 纵向研究AKI患者（定义为围手术期血清浓度升高至少25%） 肌酐和相同数量的无AKI的患者在三个学术水平上存活心脏手术 中心.我们将确定AKI是否会导致肾小球滤过率下降的增加， 随着时间的推移，蛋白质排泄率增加。我们将比较血清倍增的发生率 肌酐、透析或死亡。此外，我们还将研究新发现的 急性肾损伤的生物标志物（尿IL-18和NGAL）与CKD和死亡相关。作为肌钙蛋白 在心肌梗死的治疗中显示出巨大的价值，我们希望这些尿 生物标志物将对AKI患者具有长期预后价值。 目前，大多数医生认为AKI是一种可逆的现象， 急性期。然而，如果AKI确实与长期发病率和死亡率相关，那么AKI后 对这些患者的护理应包括更密切的警惕和更积极的治疗，以改善 长期成果。我的希望是在未来获得R01赠款，以提高风险的目标- AKI的分层，我也希望参加AKI及其相关治疗的多中心试验 并发症

项目成果

Acute kidney injury in elderly persons.

• DOI: 10.1053/j.ajkd.2009.12.034
• 发表时间: 2010-07
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Coca SG