Long-term Prognosis of Acute Kidney Injury in Cardiac Surgery

众所周知，急性肾损伤(AKI)对临床结果有显著的影响，包括短期的 死亡率。此外，AKI的发病率在过去几年中有所增加。同时， 慢性肾脏疾病的患病率很高，给患者和健康带来了沉重的负担 美国的护理体系。目前尚不清楚AKI是一种完全可逆的疾病，还是会导致 永久性肾脏损伤，从而导致慢性肾脏病和死亡。 这项建议将利用前瞻性队列设计，为 正在进行的多中心为期5天的心脏手术后尿生物标志物检测AKI的研究。我们会 围术期血清至少升高25%的AKI患者的纵向研究 肌酐和同等数量的没有AKI的患者在三个学术机构的心脏手术中存活下来 中锋。我们将确定AKI是否导致肾小球滤过率下降和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 AKI患者和非AKI患者的肌酐、透析或死亡。此外，我们还将检查新发现的 急性肾损伤的生物标志物(尿IL-18和NGAL)与慢性肾脏病和死亡有关。作为肌钙蛋白 在设置心肌梗死方面显示了巨大的价值，我们希望这些尿液 生物标记物将对AKI患者具有长期预后价值。 目前，AKI被大多数医生视为一种可逆现象，在发生AKI后几乎没有什么后果 急性期。然而，如果急性心肌梗死确实与长期发病率和死亡率有关，那么急性心肌梗死后 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 长期结果。我希望在未来获得R01拨款，目标是改善风险- AKI和我的分层也希望参与AKI及其相关疗法的多中心试验 并发症。

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.