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Açık kalp ameliyatı geçiren ileri yaştaki hastalarda akut böbrek hasarı için risk faktörleri

Year 2024, , 104 - 109, 28.03.2024
https://doi.org/10.18663/tjcl.1441211

Abstract

Amaç: Bu çalışmadaki amacımız ileri yaştaki hasta grubunda açık kalp cerrahisi sonrasında akut böbrek yetmezliğinin risk
faktörlerinin belirlenmesi ve doğru hasta seçimi yaparak bu hasta grubunda mortali-te ve morbiditeyi azalmaktır.
Gereç ve Yöntemler: Ocak 2017-aralık 2022, 678 hasta retrospektif olarak incelenmiştir. Hastalar yaşlarına göre < 70 yaş = kontrol grubu, 70–80 yaş = septuagenarian grubu, ve > 80 yaş = octogenarian grubu olarak ayrılmıştır. Yaş, cinsiyet, demografik özellikler, Euroskor, preoperatif serum kreatinin dü-zeyi, postoperatif 1. aydaki serum kreatinin düzeyleri, diyaliz ihtiyacı ve bir yıllık mortalite parametre-leri analiz edilmiştir.
Bulgular: Çalışmaya toplam 206 hasta dahi edilmiştir, bu hastalardan 94'u kontrol grubu (79 erkek), 29 hasta septuagenarian grubu (22 erkek), ve 83 hasta octogenarian grubu (70 erkek). Grupların preo-peratif serum kreatinin düzeylerinde istatistiksel olarak fark vardır. 26 hastanın renal replasman tedavi-si ihtiyacı olmuştur, bunların 6'si kontrol grubunda, 3'u septuagenarian grubunda, ve 17'si ise octoge-narian grubundadır. Renal replasman tedavisi açısından gruplar arasında istatistiksel fark vardır, ve re-nal replasman tedavisi alan hastaların 11 ölmüştür. Toplamda 22 hasta ölmüştür, bunların 4'u kontrol grubunda, 3'u septuagenarian grubunda, ve 15'i ise octogenarian grubundadır.
Sonuç: İleri yaştaki hasta grubunda doğru hasta seçimi, titiz bir cerrahi ve kusursuz miyokardiyal ko-ruma mortalite ve morbiditeyi ciddi azaltmaktadır.

Project Number

KA23/280

References

  • Peterson ED, DeLong ER, Muhlbaier LH, et al. Predicting mortality following bypass surgery in the elderly: results from the Cooperative Cardiovascular Project. Circulation 1995;92(Suppl I): 637–644.
  • Gummert JF, Funkat A, Beckmann A, et al. Cardiac surgery in Germany during 2009. A report on behalf of the German society for thoracic and cardiovascular surgery. Thorac Cardiovasc Surg 2010;58(7): 379–386. (DOI: 10.1055/s-0030-1250294)
  • Alexander KP, Anstrom KJ, Muhlbaier LH, et al. Outcomes of cardiac surgery in patients age ≥ 80 years: results from the National Cardiovascular Network. Journal of the American College of Cardiology 2000;35(3): 731–738. (DOI: 10.1016/s0735-1097(99)00606-3)
  • Hansen MK, Gammelager H, Jacobsen CJ, et al. Acute kidney injury and long-term risk of cardi-ovascular events after cardiac surgery: a population-based cohort study. J Cardiothorac Vasc Anesth 2015;29(3): 617–625. (DOI: 10.1053/j.jvca.2014.08.020)
  • Brown JR, Kramer RS, MacKenzie TA, Coca SG, Sint K, Parikh CR. Determinants of acute kidney injury duration after cardiac surgery: an externally validated tool. Ann Thorac Surg 2012;93(2): 570–576. (DOI: 10.1016/j.athorascur.2011.11.004)
  • Lakatta EG. Cardiovascular aging research: the next horizons. Journal of the American Geriat-rics Society 1999;47 (5): 613–625. (DOI: 10.1111/j.1532-5415.1999.tb02579.x)
  • Koc M, Kutsal A. Vascular aging. Turkish Journal of Geriatrics 2015;2: 156–161.
  • Olivetti G, Melissari M, Capasso JM, Anversa P. Cardiomyopathy of the aging human heart. Myocyte loss and reactive cellular hypertrophy. Circulation Research 1991;68(6): 1560–1568. (DOI: 10.1161/01.res.68.6.1560)
  • Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury. Blood Purif. 2014;37(Suppl 2): 34–50. (DOI:10.1159/000361062).
  • Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kid Int Suppl. 2012;2(1): 1–138. (DOI:10.1038/kisup.2012.1).
  • Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(2): 179–184. (DOI: 10.1159/000339789)
  • Ried M, Puehler T, Haneya A, Schmid C, Diez C. Acute kidney injury in septua- and octogenari-ans after cardiac surgery. BMC Cardiovascular Disorders 2011;11(1): 52. http://www.biomedcentral.com/1471-2261/11/52. (doi:10.1186/1471-2261-11-52)
  • Palomba H, Castro I, Neto ALC, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score Kidney Int. 2007 Sep;72(5): 624–31. (DOI: 10.1038/sj.ki.5002419). Epub 2007 Jul 11.
  • Deschka H, Schreier R, El-Ayoubi L, et al. Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden? Interact Cardiovasc Thorac Surg. 2013;17(3): 501–6. (DOI:10.1093/icvts/ivt229)
  • Mézière A, Paillaud E, Plaud B. Anesthesia in the elderly. Presse Med. 2013;42(2): 197–201. (DOI:10.1016/j.lpm.2012.07.040)
  • Li Z, Fan G, Zheng X, et al. Risk factors and clinical significance of acute kidney injury after on-pump or off-pump coronary artery bypass grafting: a propensity score-matched study. Interact Cardiovasc Thorac Surg 2019;28(6): 893–899. (DOI:10.1093/icvts/ivy353)
  • Mao MA, Thongprayoon C, Wu YF, et al. Incidence, severity, and outcomes of acute kidney in-jury in octogenarians following heart valve replacement surgery. Int Journal of Nephrology 2015: 1-8. (DOI:10.1155/2015/237951).
  • Wang W, Bagshaw SM, Norris CM, Zibdawi R, Zibdawi M, MacArthur R. Association between older age and outcome after cardiac surgery: a population-based cohort study. Journal of Cardi-othoracic Surgery 2014;9(1): 1-9. (DOI:10.1186/s13019-014-0177-6)
  • Zangrillo A, Crescenzi G, Landoni G, et al. Off-pump coronary artery bypass grafting reduces postoperative neurologic complications compared to CPB. J Cardiothorac Vasc Anesth. 2005;19(2): 193–6. (DOI:10.1053/j.jvca.2005.01.030)
  • Paparella D, Brister SJ, Buchanan MR. Coagulation disorders of cardiopulmonary bypass: a re-view. Intensive Care Med. 2004;30(10): 1873–81. (DOI:10.1007/s00134-004-2388-0)
  • Saleh HZ, Shaw M, Fabri BM, Chalmers JAC. Does avoidance of cardiopulmonary bypass confer any benefits in octogenarians undergoing coronary surgery? Interactive Cardiovascular and Thora-cic Surgery 2011;12(3): 435–439. (DOI:10.1510/icvts.2010.249789)
  • LaPar DJ, Bhamidipati CM, Reece TB, Cleveland JC, Kron IL, Ailawadi G. Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians? Journal of Thoracic and Cardiovascular Surgery 2011;141(1): 81–90. (DOI:10.1016/j.jtcvs.2010.09.012)
  • Nicolini F, Agostinelli A, Vezzani A, et al. The evolution of cardiovascular surgery in elderly patients: a review of current options and outcomes. BioMed Research International 2014;Article ID 736298: 10 pages. (DOI:10.1155/2014/736298).
  • Thongprayoon C, Cheungpasitporn W, Lin J, Mao MA, Qian Q. Acute kidney injury in octogena-rians after heart valve replacement surgery: a study of two periods over the last decade. Clinical Kidney Journal 2017;10(5): 648–654. (DOI: 10.1093/ckj/sfx016).

Risk factors for acute kidney injury in octogenarians undergoing open-heart surgery: Decrea-sing mortality and morbidity

Year 2024, , 104 - 109, 28.03.2024
https://doi.org/10.18663/tjcl.1441211

Abstract

Aim: Our studys goal is, to determine the risk factors for acute kidney injury in octogenarians un-dergoing open-heart surgery to decrease mortality and morbidity by enhancing accurate patient selection in the preoperative period. Material and Methods: Between January 2017-December 2022, 678 patients analyzed retros-pectively. The patient groups were divided as follows: < 70 years old = control group, 70–80 years old = septuagenarian group, and > 80 years old = octogenarian group. Age, sex, ethnicity, Eurosco-re, preoperative serum creatinine levels, postoperative first-month serum creatinine levels, dialy-sis requirements, and first-year mortality parameters were analyzed.
Results: 206 patients has included into study, with 94 patients in the control group (79 male), 29 patients in the septuagenarian group (22 male), and 83 patients in the octogenarian group (70 male). There was a statistically significant difference between the groups based on preoperative serum creatinine. Of the 26 patients requiring renal replacement therapy, 6 were in the control group, 3 were in the septuagenarian group, and 17 were in the octogenarian group. There was a statistically significant difference between groups based on requiring renal replacement therapy, and 11 of the patients requiring renal replacement therapy died. Of the 22 patients who died ove-rall, 4 were in the control group, 3 were in the septuagenarian group, and 15 were in the octoge-narian group.
Conclusion: In the senior patient group, the best approach for optimal patient selection is to ensu-re meticulous surgical technique and myocardial protection.

Ethical Statement

E-91694447-604.01.02-262243 sayı ile başvurulan etik kuruldan KA23/280 numara ile etik onay alınılmıştır. Çalışma retrospektif olarak yapılmış olup çalışmada herhangi bir etik ihlal yapılmamıştır.

Supporting Institution

Başkent Üniversitesi Tıp Fakültesi

Project Number

KA23/280

Thanks

Başkent Üniversitesi Kalp Damar Cerrahisi

References

  • Peterson ED, DeLong ER, Muhlbaier LH, et al. Predicting mortality following bypass surgery in the elderly: results from the Cooperative Cardiovascular Project. Circulation 1995;92(Suppl I): 637–644.
  • Gummert JF, Funkat A, Beckmann A, et al. Cardiac surgery in Germany during 2009. A report on behalf of the German society for thoracic and cardiovascular surgery. Thorac Cardiovasc Surg 2010;58(7): 379–386. (DOI: 10.1055/s-0030-1250294)
  • Alexander KP, Anstrom KJ, Muhlbaier LH, et al. Outcomes of cardiac surgery in patients age ≥ 80 years: results from the National Cardiovascular Network. Journal of the American College of Cardiology 2000;35(3): 731–738. (DOI: 10.1016/s0735-1097(99)00606-3)
  • Hansen MK, Gammelager H, Jacobsen CJ, et al. Acute kidney injury and long-term risk of cardi-ovascular events after cardiac surgery: a population-based cohort study. J Cardiothorac Vasc Anesth 2015;29(3): 617–625. (DOI: 10.1053/j.jvca.2014.08.020)
  • Brown JR, Kramer RS, MacKenzie TA, Coca SG, Sint K, Parikh CR. Determinants of acute kidney injury duration after cardiac surgery: an externally validated tool. Ann Thorac Surg 2012;93(2): 570–576. (DOI: 10.1016/j.athorascur.2011.11.004)
  • Lakatta EG. Cardiovascular aging research: the next horizons. Journal of the American Geriat-rics Society 1999;47 (5): 613–625. (DOI: 10.1111/j.1532-5415.1999.tb02579.x)
  • Koc M, Kutsal A. Vascular aging. Turkish Journal of Geriatrics 2015;2: 156–161.
  • Olivetti G, Melissari M, Capasso JM, Anversa P. Cardiomyopathy of the aging human heart. Myocyte loss and reactive cellular hypertrophy. Circulation Research 1991;68(6): 1560–1568. (DOI: 10.1161/01.res.68.6.1560)
  • Mao H, Katz N, Ariyanon W, et al. Cardiac surgery-associated acute kidney injury. Blood Purif. 2014;37(Suppl 2): 34–50. (DOI:10.1159/000361062).
  • Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kid Int Suppl. 2012;2(1): 1–138. (DOI:10.1038/kisup.2012.1).
  • Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(2): 179–184. (DOI: 10.1159/000339789)
  • Ried M, Puehler T, Haneya A, Schmid C, Diez C. Acute kidney injury in septua- and octogenari-ans after cardiac surgery. BMC Cardiovascular Disorders 2011;11(1): 52. http://www.biomedcentral.com/1471-2261/11/52. (doi:10.1186/1471-2261-11-52)
  • Palomba H, Castro I, Neto ALC, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score Kidney Int. 2007 Sep;72(5): 624–31. (DOI: 10.1038/sj.ki.5002419). Epub 2007 Jul 11.
  • Deschka H, Schreier R, El-Ayoubi L, et al. Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden? Interact Cardiovasc Thorac Surg. 2013;17(3): 501–6. (DOI:10.1093/icvts/ivt229)
  • Mézière A, Paillaud E, Plaud B. Anesthesia in the elderly. Presse Med. 2013;42(2): 197–201. (DOI:10.1016/j.lpm.2012.07.040)
  • Li Z, Fan G, Zheng X, et al. Risk factors and clinical significance of acute kidney injury after on-pump or off-pump coronary artery bypass grafting: a propensity score-matched study. Interact Cardiovasc Thorac Surg 2019;28(6): 893–899. (DOI:10.1093/icvts/ivy353)
  • Mao MA, Thongprayoon C, Wu YF, et al. Incidence, severity, and outcomes of acute kidney in-jury in octogenarians following heart valve replacement surgery. Int Journal of Nephrology 2015: 1-8. (DOI:10.1155/2015/237951).
  • Wang W, Bagshaw SM, Norris CM, Zibdawi R, Zibdawi M, MacArthur R. Association between older age and outcome after cardiac surgery: a population-based cohort study. Journal of Cardi-othoracic Surgery 2014;9(1): 1-9. (DOI:10.1186/s13019-014-0177-6)
  • Zangrillo A, Crescenzi G, Landoni G, et al. Off-pump coronary artery bypass grafting reduces postoperative neurologic complications compared to CPB. J Cardiothorac Vasc Anesth. 2005;19(2): 193–6. (DOI:10.1053/j.jvca.2005.01.030)
  • Paparella D, Brister SJ, Buchanan MR. Coagulation disorders of cardiopulmonary bypass: a re-view. Intensive Care Med. 2004;30(10): 1873–81. (DOI:10.1007/s00134-004-2388-0)
  • Saleh HZ, Shaw M, Fabri BM, Chalmers JAC. Does avoidance of cardiopulmonary bypass confer any benefits in octogenarians undergoing coronary surgery? Interactive Cardiovascular and Thora-cic Surgery 2011;12(3): 435–439. (DOI:10.1510/icvts.2010.249789)
  • LaPar DJ, Bhamidipati CM, Reece TB, Cleveland JC, Kron IL, Ailawadi G. Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians? Journal of Thoracic and Cardiovascular Surgery 2011;141(1): 81–90. (DOI:10.1016/j.jtcvs.2010.09.012)
  • Nicolini F, Agostinelli A, Vezzani A, et al. The evolution of cardiovascular surgery in elderly patients: a review of current options and outcomes. BioMed Research International 2014;Article ID 736298: 10 pages. (DOI:10.1155/2014/736298).
  • Thongprayoon C, Cheungpasitporn W, Lin J, Mao MA, Qian Q. Acute kidney injury in octogena-rians after heart valve replacement surgery: a study of two periods over the last decade. Clinical Kidney Journal 2017;10(5): 648–654. (DOI: 10.1093/ckj/sfx016).
There are 24 citations in total.

Details

Primary Language English
Subjects Cardiovascular Surgery
Journal Section Research Article
Authors

Deniz Sarp Beyazpınar 0000-0001-5415-7036

Mehmet Emir Erol 0000-0002-7679-3575

Project Number KA23/280
Publication Date March 28, 2024
Submission Date February 25, 2024
Acceptance Date March 15, 2024
Published in Issue Year 2024

Cite

APA Beyazpınar, D. S., & Erol, M. E. (2024). Açık kalp ameliyatı geçiren ileri yaştaki hastalarda akut böbrek hasarı için risk faktörleri. Turkish Journal of Clinics and Laboratory, 15(1), 104-109. https://doi.org/10.18663/tjcl.1441211
AMA Beyazpınar DS, Erol ME. Açık kalp ameliyatı geçiren ileri yaştaki hastalarda akut böbrek hasarı için risk faktörleri. TJCL. March 2024;15(1):104-109. doi:10.18663/tjcl.1441211
Chicago Beyazpınar, Deniz Sarp, and Mehmet Emir Erol. “Açık Kalp Ameliyatı geçiren Ileri yaştaki Hastalarda Akut böbrek Hasarı için Risk faktörleri”. Turkish Journal of Clinics and Laboratory 15, no. 1 (March 2024): 104-9. https://doi.org/10.18663/tjcl.1441211.
EndNote Beyazpınar DS, Erol ME (March 1, 2024) Açık kalp ameliyatı geçiren ileri yaştaki hastalarda akut böbrek hasarı için risk faktörleri. Turkish Journal of Clinics and Laboratory 15 1 104–109.
IEEE D. S. Beyazpınar and M. E. Erol, “Açık kalp ameliyatı geçiren ileri yaştaki hastalarda akut böbrek hasarı için risk faktörleri”, TJCL, vol. 15, no. 1, pp. 104–109, 2024, doi: 10.18663/tjcl.1441211.
ISNAD Beyazpınar, Deniz Sarp - Erol, Mehmet Emir. “Açık Kalp Ameliyatı geçiren Ileri yaştaki Hastalarda Akut böbrek Hasarı için Risk faktörleri”. Turkish Journal of Clinics and Laboratory 15/1 (March 2024), 104-109. https://doi.org/10.18663/tjcl.1441211.
JAMA Beyazpınar DS, Erol ME. Açık kalp ameliyatı geçiren ileri yaştaki hastalarda akut böbrek hasarı için risk faktörleri. TJCL. 2024;15:104–109.
MLA Beyazpınar, Deniz Sarp and Mehmet Emir Erol. “Açık Kalp Ameliyatı geçiren Ileri yaştaki Hastalarda Akut böbrek Hasarı için Risk faktörleri”. Turkish Journal of Clinics and Laboratory, vol. 15, no. 1, 2024, pp. 104-9, doi:10.18663/tjcl.1441211.
Vancouver Beyazpınar DS, Erol ME. Açık kalp ameliyatı geçiren ileri yaştaki hastalarda akut böbrek hasarı için risk faktörleri. TJCL. 2024;15(1):104-9.


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