Кардиоваскулярная терапия и профилактика (Jun 2015)

THE RISK OF ACUTE KIDNEY INJURY AND ITS PROGNOSTIC VALUE IN PATIENTS WITH VARIOUS GLOMERULAR FILTRATION RATES, UNDERWENT AORTOCORONARY BYPASS GRAFTING

  • B. G. Iskenderov,
  • O. N. Sisina,
  • M. N. Mamedov

DOI
https://doi.org/10.15829/1728-8800-2015-3-54-59
Journal volume & issue
Vol. 14, no. 3
pp. 54 – 59

Abstract

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Aim. To assess the risk factors of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) and to evaluate their prognostic value in short- term and long-term periods after aortocoronary bypass grafting (CBG). Material and methods. Totally 733 patients studied (476 men and 257 women) with the age 47-66 y.o. (mean age — 60,3±5,8 y.), underwent planned CBG. According to preoperational level of glomerular filtration rate (GFR) patients were selected into 3 groups: 352 patients with GFR >90 ml/min/1,73 m2 (I group); in 311 patients — 89-60 ml/min/1,73 m2 (II group) and in 70 patients — 59-45 ml/min/1,73 m2 (III group). AKI was diagnosed and classified by the level of serum creatinine (sCr), using AKIN criteria (Acute Kidney Injury Network). Dynamical observation of patients was performed for 12 months after discharge.Results. During early post-operation period the AKI diagnosed in 32,6% patients, including I group in 23,0%, the II group in 37,9% and the III group in 55,7%. Hospital mortality in the I group was 3,1%, in the II — 9,1% and in the III — 12,9% (p<0,05). In the I group the development of CKD in patients after AKI, was found in 5,6% cases, and progression of CKD in the II group — in 8,6% cases and in the III group — 15,8% cases. Contrary, the regression of CKD in the II group was found in 61,5% cases, including those after AKI, in 55,5% cases and in patients without AKI in 67,2% cases. In the III group the regression of CKD was found in 40,4% cases (p=0,005) and there were no differences related to AKI. Programmed hemodialysis in the I group was performed for 2,1% patients, in the II group — for 5,3% patients and in the III group — for 22,8% patients, significant intergroup differences.After 12 months of observation total mortality in the I group was 2,6%, in the II — 6,6% and in the III group — 17,5%.Conclusion. Therefore, presence and severity of CKD, development of postoperational AKI predetermine short- and long-term cardiorenal prognosis in patients after CBG.

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