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Колебания уровня сывороточного креатинина и контрастиндуцированное острое повреждение почек у больных со стабильной ишемической болезнью сердца
Колебания уровня сывороточного креатинина и контрастиндуцированное острое повреждение почек у больных со стабильной ишемической болезнью сердца
Миронова О.Ю., Фомин В.В. Колебания уровня сывороточного креатинина и контрастиндуцированное острое повреждение почек у больных со стабильной ишемической болезнью сердца. Consilium Medicum. 2020; 22 (10): 72–75. DOI: 10.26442/20751753.2020.10.200358
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Аннотация
Цель. Изучение влияния различных факторов риска на риск развития контрастиндуцированного острого повреждения почек (КИ-ОПП) у пациентов со стабильной ишемической болезнью сердца.
Материалы и методы. В работу включены пациенты, проходившие лечение в условиях стационара с диагнозом «хроническая ишемическая болезнь сердца», получавшие оптимальную медикаментозную терапию и имеющие показания для проведения коронароангиографии с возможной ангиопластикой. Исследование являлось открытым проспективным наблюдательным когортным клиническим. Протокол зарегистрирован в системе clinicaltrials.gov под номером NCT04014153.
Результаты. В работу включены 1023 пациента. Большинство являлись лицами мужского пола в возрасте 61,7±10,1 года с повышенной массой тела и страдали артериальной гипертензией. КИ-ОПП развилось у 132 (12,9%) больных. При проведении анализа частоты КИ-ОПП в соответствии с определением, подразумевающим абсолютное повышение сывороточного креатинина, частота КИ-ОПП составила всего 18 (1,8%) больных. В полученной модели логистической регрессии статистически значимыми оказались исходные значения сывороточного креатинина, исходная скорость клубочковой фильтрации, и наиболее статистически значимой стала разница между уровнями креатинина до и после введения контрастного вещества. Площадь под кривой (area under the curve – AUC) составила 0,984 (95% доверительный интервал 0,969–0,999; p<0,0001).
Заключение. Среди проанализированных факторов риска в логистической регрессионной модели наиболее значимыми являлись исходные уровни креатинина, скорость клубочковой фильтрации и разница между уровнями креатинина до и после введения контраста.
Ключевые слова: контрастиндуцированное острое повреждение почек, контрастиндуцированная нефропатия, контрастассоциированное острое повреждение почек, ишемическая болезнь сердца, чрескожное коронарное вмешательство, контрастное вещество, креатинин.
Materials and methods. Patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angioplasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153.
Results. We included 1023 patients with chronic CAD. Most of the patients, included in the study, were males aged 61.7±10.1 years with arterial hypertension and overweight. The rate of CI-AKI in this group was 12.9% (132 patients). The rate of CI-AKI using the absolute creatinine rise definition was 1.8% cases
(18 cases). A logistic regression model was created, where baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors. The AUC was 0.984 (95% CI 0.969–0.999; p<0.0001).
Conclusion. The most significant risk factors in the logistic regression model created were baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors.
Key words: contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, contrast, creatinine.
Материалы и методы. В работу включены пациенты, проходившие лечение в условиях стационара с диагнозом «хроническая ишемическая болезнь сердца», получавшие оптимальную медикаментозную терапию и имеющие показания для проведения коронароангиографии с возможной ангиопластикой. Исследование являлось открытым проспективным наблюдательным когортным клиническим. Протокол зарегистрирован в системе clinicaltrials.gov под номером NCT04014153.
Результаты. В работу включены 1023 пациента. Большинство являлись лицами мужского пола в возрасте 61,7±10,1 года с повышенной массой тела и страдали артериальной гипертензией. КИ-ОПП развилось у 132 (12,9%) больных. При проведении анализа частоты КИ-ОПП в соответствии с определением, подразумевающим абсолютное повышение сывороточного креатинина, частота КИ-ОПП составила всего 18 (1,8%) больных. В полученной модели логистической регрессии статистически значимыми оказались исходные значения сывороточного креатинина, исходная скорость клубочковой фильтрации, и наиболее статистически значимой стала разница между уровнями креатинина до и после введения контрастного вещества. Площадь под кривой (area under the curve – AUC) составила 0,984 (95% доверительный интервал 0,969–0,999; p<0,0001).
Заключение. Среди проанализированных факторов риска в логистической регрессионной модели наиболее значимыми являлись исходные уровни креатинина, скорость клубочковой фильтрации и разница между уровнями креатинина до и после введения контраста.
Ключевые слова: контрастиндуцированное острое повреждение почек, контрастиндуцированная нефропатия, контрастассоциированное острое повреждение почек, ишемическая болезнь сердца, чрескожное коронарное вмешательство, контрастное вещество, креатинин.
________________________________________________
Materials and methods. Patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angioplasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153.
Results. We included 1023 patients with chronic CAD. Most of the patients, included in the study, were males aged 61.7±10.1 years with arterial hypertension and overweight. The rate of CI-AKI in this group was 12.9% (132 patients). The rate of CI-AKI using the absolute creatinine rise definition was 1.8% cases
(18 cases). A logistic regression model was created, where baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors. The AUC was 0.984 (95% CI 0.969–0.999; p<0.0001).
Conclusion. The most significant risk factors in the logistic regression model created were baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors.
Key words: contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, contrast, creatinine.
Полный текст
Список литературы
1. KDIGO Working Group. Clinical Practice Guideline for Acute Kidney Injury. Kidney Int (Suppl.) 2012; 2 (1): 124–38. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO AKI Guideline.pdf
2. Chertow GM, Burdick E, Honour M et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16 (11): 3365–70.
3. Lassnigg A, Schmidlin D, Mouhieddine M et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol 2004; 15 (6): 1597–605.
4. Hoste EAJ, Clermont G, Kersten A et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006; 10 (3): 1–10.
5. Amdur RL, Chawla LS, Amodeo S et al. Outcomes following diagnosis of acute renal failure in U.S. veterans : focus on acute tubular necrosis. Kidney Int 2009; 76 (10): 1089–97. DOI: 10.1038/ki.2009.332
6. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: An integrated clinical syndrome. Kidney Int 2012; 82 (5): 516–24. DOI: 10.1038/ki.2012.208
7. Ronco C, Levin A, Mehta RL et al. Improving outcomes from acute kidney injury: Report of an initiative. Int J Artif Organs 2007; 30 (5): 373–6.
8. Mehta RL, Kellum JA, Shah SV et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (2): 1–8.
9. Thomas ME, Blaine C, Dawnay A et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87.
10. Srisawat N, Kellum JA. The Role of Biomarkers in Acute Kidney Injury. Crit Care Clin 2020; 36 (1): 125–40. DOI: 10.1016/j.ccc.2019.08.010
11. Williams B, Mancia G, De Backer G et al. 2018 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2018; 25 (6): 1105–87.
12. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med 2019; 380 (22): 2146–55. DOI: 10.1056/NEJMra1805256
13. Mehran R, Aymong ED, Nikolsky E et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44 (7): 1393–9. DOI: 10.1016/j.jacc.2004.06.068
14. Maioli M, Toso A, Gallopin M et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med 2010; 11 (6): 444–9.
2. Chertow GM, Burdick E, Honour M et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16 (11): 3365–70.
3. Lassnigg A, Schmidlin D, Mouhieddine M et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol 2004; 15 (6): 1597–605.
4. Hoste EAJ, Clermont G, Kersten A et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006; 10 (3): 1–10.
5. Amdur RL, Chawla LS, Amodeo S et al. Outcomes following diagnosis of acute renal failure in U.S. veterans : focus on acute tubular necrosis. Kidney Int 2009; 76 (10): 1089–97. DOI: 10.1038/ki.2009.332
6. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: An integrated clinical syndrome. Kidney Int 2012; 82 (5): 516–24. DOI: 10.1038/ki.2012.208
7. Ronco C, Levin A, Mehta RL et al. Improving outcomes from acute kidney injury: Report of an initiative. Int J Artif Organs 2007; 30 (5): 373–6.
8. Mehta RL, Kellum JA, Shah SV et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (2): 1–8.
9. Thomas ME, Blaine C, Dawnay A et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87.
10. Srisawat N, Kellum JA. The Role of Biomarkers in Acute Kidney Injury. Crit Care Clin 2020; 36 (1): 125–40. DOI: 10.1016/j.ccc.2019.08.010
11. Williams B, Mancia G, De Backer G et al. 2018 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2018; 25 (6): 1105–87.
12. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med 2019; 380 (22): 2146–55. DOI: 10.1056/NEJMra1805256
13. Mehran R, Aymong ED, Nikolsky E et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44 (7): 1393–9. DOI: 10.1016/j.jacc.2004.06.068
14. Maioli M, Toso A, Gallopin M et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med 2010; 11 (6): 444–9.
2. Chertow GM, Burdick E, Honour M et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16 (11): 3365–70.
3. Lassnigg A, Schmidlin D, Mouhieddine M et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol 2004; 15 (6): 1597–605.
4. Hoste EAJ, Clermont G, Kersten A et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006; 10 (3): 1–10.
5. Amdur RL, Chawla LS, Amodeo S et al. Outcomes following diagnosis of acute renal failure in U.S. veterans : focus on acute tubular necrosis. Kidney Int 2009; 76 (10): 1089–97. DOI: 10.1038/ki.2009.332
6. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: An integrated clinical syndrome. Kidney Int 2012; 82 (5): 516–24. DOI: 10.1038/ki.2012.208
7. Ronco C, Levin A, Mehta RL et al. Improving outcomes from acute kidney injury: Report of an initiative. Int J Artif Organs 2007; 30 (5): 373–6.
8. Mehta RL, Kellum JA, Shah SV et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (2): 1–8.
9. Thomas ME, Blaine C, Dawnay A et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87.
10. Srisawat N, Kellum JA. The Role of Biomarkers in Acute Kidney Injury. Crit Care Clin 2020; 36 (1): 125–40. DOI: 10.1016/j.ccc.2019.08.010
11. Williams B, Mancia G, De Backer G et al. 2018 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2018; 25 (6): 1105–87.
12. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med 2019; 380 (22): 2146–55. DOI: 10.1056/NEJMra1805256
13. Mehran R, Aymong ED, Nikolsky E et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44 (7): 1393–9. DOI: 10.1016/j.jacc.2004.06.068
14. Maioli M, Toso A, Gallopin M et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med 2010; 11 (6): 444–9.
________________________________________________
2. Chertow GM, Burdick E, Honour M et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16 (11): 3365–70.
3. Lassnigg A, Schmidlin D, Mouhieddine M et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol 2004; 15 (6): 1597–605.
4. Hoste EAJ, Clermont G, Kersten A et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006; 10 (3): 1–10.
5. Amdur RL, Chawla LS, Amodeo S et al. Outcomes following diagnosis of acute renal failure in U.S. veterans : focus on acute tubular necrosis. Kidney Int 2009; 76 (10): 1089–97. DOI: 10.1038/ki.2009.332
6. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: An integrated clinical syndrome. Kidney Int 2012; 82 (5): 516–24. DOI: 10.1038/ki.2012.208
7. Ronco C, Levin A, Mehta RL et al. Improving outcomes from acute kidney injury: Report of an initiative. Int J Artif Organs 2007; 30 (5): 373–6.
8. Mehta RL, Kellum JA, Shah SV et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (2): 1–8.
9. Thomas ME, Blaine C, Dawnay A et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87.
10. Srisawat N, Kellum JA. The Role of Biomarkers in Acute Kidney Injury. Crit Care Clin 2020; 36 (1): 125–40. DOI: 10.1016/j.ccc.2019.08.010
11. Williams B, Mancia G, De Backer G et al. 2018 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2018; 25 (6): 1105–87.
12. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med 2019; 380 (22): 2146–55. DOI: 10.1056/NEJMra1805256
13. Mehran R, Aymong ED, Nikolsky E et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44 (7): 1393–9. DOI: 10.1016/j.jacc.2004.06.068
14. Maioli M, Toso A, Gallopin M et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med 2010; 11 (6): 444–9.
Авторы
О.Ю. Миронова*, В.В. Фомин
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*mironova_o_yu@staff.sechenov.ru
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*mironova_o_yu@staff.sechenov.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*mironova_o_yu@staff.sechenov.ru
________________________________________________
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*mironova_o_yu@staff.sechenov.ru
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