ymjЯкутский медицинский журналYakut Medical Journal1813-19052312-1017ЯНЦ КМП10.25789/YMJ.2020.70.06ymj-675Research ArticleМЕТОДЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯMETHODS OF DIAGNOSIS AND TREATMENTПрогнозирование острого повреждения почек у пациентов с ишемической болезнью сердца при реваскуляризации миокарда шунтирующими методамиPredicting acute kidney injury in CAD patients undergoing coronary artery bypass graftingКоростелевА. С.KorostelevA. S.

Коростелев Александр Сергеевич – доцент

Korostelev Aleksandr Sergeevich – anesthesiologist-resuscitator, Department of Anesthesiology, Resuscitation and Intensive Care (Cardiology)

677000, Sakha Republic (Yakutia), Yakutsk, ul. Oyunskogo, 27. Tel/fax. +7 (4112) 363489. Mob. +7-924- 763-9300

bezbazaroff@inbox.ruПотаповА. Ф.PotapovA. F.

Потапов Александр Филиппович – д.м.н., зав. Кафедрой

Potapov Aleksandr Filippovich – Doctor of Medical Sciences, Head, Department of Anesthesiology, Resuscitation and Intensive Care with Emergency Care Course, Faculty of Post-graduate Studies for Doctors, Institute of Medicine

potapov-paf@mail.ruИвановаА. А.IvanovaA. A.

Иванова Альбина Аммосовна – д.м.н., проф.

Ivanova Albina Ammosovna – Doctor of Medicine, Associate Professor, Department of Anesthesiology, Reanimation and Intensive Care, Institute for Post-graduate Medical Training

iaa_60@mail.ruЗахаровП. И.ZakharovP. I.

Захаров Петр Иванович – д.м.н., врач сердечно-сосудистый хирург, зав. отд. Клинического центра

г. Якутск

Zakharov Petr Ivanovich – Doctor of Medical Sciences, chief external expert in cardiovascular surgery, Head, Cardiovascular Surgery Department, Clinical Center

pizaharov@mail.ruБулатовА. В.BulatovA. V.

Булатов Алквиад Валентинович – к.м.н., доцент;

зав. отд.

Bulatov Alkviad Valentinovich – Candidate of Medical Sciences Head, Department of Anesthesiology, Resuscitation and Intensive Care (Cardiology)

alkviad06@mail.ruМИ СВФУ им. М.К. АммосоваРоссияState autonomous institution of the Sakha Republic (Yakutia) “Republic’s Hospital No. 1 - National Center of Medicine."Russian FederationМИ СВФУ им. М.К. АммосоваРоссияFederal state educational institution of higher professional education "M.K.Ammosov North-Eastern Federal University"Russian FederationМИ СВФУ им. М.К. АммосоваРоссияAmmosov North-Eastern Federal UniversityRussian FederationРБ №1-НЦМРоссияState autonomous institution of the Sakha Republic (Yakutia) “Republic’s Hospital No. 1 - National Center of Medicine."Russian FederationМИ СВФУ им. М.К. Аммосова; РБ №1- НЦМРоссияState autonomous institution of the Sakha Republic (Yakutia) “Republic’s Hospital No. 1 - National Center of Medicine."Russian Federation202017052025022124Copyright © Коростелев А.С., Потапов А.Ф., Иванова А.А., Захаров П.И., Булатов А.В., 20252025Коростелев А.С., Потапов А.Ф., Иванова А.А., Захаров П.И., Булатов А.В.Korostelev A.S., Potapov A.F., Ivanova A.A., Zakharov P.I., Bulatov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ymj.elpub.ru/jour/article/view/675

Целью исследования явилось определение предикторов риска развития острого повреждения почек (ОПП) и разработка карты прогноза ОПП у пациентов с ишемической болезнью сердца при шунтирующих операциях на работающем сердце.Признаки ОПП в послеоперационном периоде наблюдались у 42,4% больных. Среди множества факторов с применением шагов метода обратного исключения Вальда выбраны 17 наиболее значимых признаков риска развития ОПП, с использованием которых построены прогностические модели (1) и (2). Также установлено возрастание вероятности развития ОПП при сопутствующем метаболическом синдроме.

The aim of the study was to identify the risk predictors of developing acute kidney injury (AKI) and to create an AKI prognosis chart for patients with coronary artery disease (CAD) undergoing off-pump coronary artery bypass grafting.The signs of AKI after the surgery were observed in 42.4% of patients. Out of the numerous factors, 17 most significant signs of the risk of developing AKI were selected using the Wald test. Using the identified signs, we built models (1) and (2) for predicting the probability of developing AKI with the sensitivity of 81% and specificity of 91%. We also revealed increased probability of developing AKI in patients with concomitant metabolic syndrome.

ишемическая болезнь сердцаметаболический синдромшунтирующая реваскуляризация миокарда на работающем сердцеострое повреждение почекпредикторы рискапрогностическая модельcoronary artery diseasemetabolic syndromeoff-pump coronary artery bypass graftingacute kidney injuryrisk predictorsprediction modelReferencesИскендеров Б.Г. Факторы риска и исходы острого повреждения почек у пациентов с сохранной функцией почек, подвергнутых аорто-коронарному шунтированию / Б.Г. Искендеров, О.Н. Сисина // Нефрология. – 2013. – Т.3. – С.7-63.Iskenderov B. G. Risk factors and outcomes of acute kidney injury in patients with intact renal function underwent coronary artery bypass grafting / B. G. Iskenderov, O.N. Sisina // Nephrology. – 2013. – Vol. 3. – P.7- 63.Кобалава Ж.Д. Концепция кардиоренальных и метаболических соотношений в современной профилактической кардиологии / Ж.Д. Кобалава, В.С. Моисеев // Кардиоваскулярная терапия и профилактика. – 2008. – Т4.– С. 4-7.Kobalava Z.D. The concept of cardiorenal and metabolic relationships in modern preventive cardiology / Z.D. Kobalava, V.S. Moiseev // Cardiovascular Therapy and Prevention. – 2008. – V4. – P. 4-7.Мельник А.А. Метаболический синдром и риск хронической болезни почек / А.А. Мельник // Почки. – 2017. – Т. 6, № 2. – С.80-90.Melnik A.A. Metabolic syndrome and risk of chronic kidney disease / A.A. Melnik // J. Kidney. – 2017. – Vol. 6. – № 2. – P. 80 – 90.Острое повреждение почек после аортокоронарного шунтирования на работающем сердце: прогнозирование исходов / О.А. Миролюбова, М.А. Алексеева, А.С. Яковлева, А.Н. Шонбин [и др.] // Нефрология и диализ. – М., 2014 –Т.16, № 3. – С. 350-358.Acute kidney injury after CABG without cardiopulmonary bypass: prediction of outcomes / O.A. Mirolyubova M.A. Alekseeva, A.S. Yakovleva, A.N. Shonbin [et al.] // Nephrology and Dialyze. – М., 2014.– V. 16. – № 3. – P. 350 – 358.Практическая кардиоанестезиология / ред. Ф.А. Хенсли, мл., Д.Е. Мартин, Г.П. Грэвли; пер. с англ. под ред. А.А. Бунятяна; пер. Е.А. Хоменко, А.А. Никитин, С.А. Циклинский, А.Н. Дьячков; науч. ред. Ю.А. Шнейдер, М.Л. Гордеев, А.Е. Баутин. – 5-е изд. – М.: Медицинское информационное агентство, 2017.A practical approach to cardiac anesthesia / editors, Frederick A. Hensley Jr., Donald E. Martin, Glenn P. Gravlee. - 5th ed., transl. version. – М., 2017.Рекомендации по ведению больных с метаболическим синдромом: клинические рекомендации МЗ РФ 2013. – 42 с.Clinical guidelines for the management of patients with metabolic syndrome. RF Ministry of Health care. – M., – 2013.- 42 p.Association of dyslipidemia with renal outcomes in chronic kidney disease / S.C. Chen, C.C. Hung, M.C. Kuo [et al.] // PLoS One. – 2013. – № 8(2). – Е55643.Association of dyslipidemia with renal outcomes in chronic kidney disease / S.C. Chen, C.C. Hung, M.C. Kuo [et al.] // PLoS One. – 2013. – № 8(2). – Е55643.Burden R. Identification, management and referral of adults with chronic kidney disease: concise guidelines / R. Burden, C. Tomson // Clin. Med. – 2005. – Vol. 5. – P. 635–642.Burden R. Identification, management and referral of adults with chronic kidney disease: concise guidelines / R. Burden, C. Tomson // Clin. Med. – 2005. – Vol. 5. – P. 635–642.Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative/ C. Ronco, P. McCullough, S. Anker [et al.] // Eur. Heart J.- 2010.- Vol. 3. - P. 703-711.Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative/ C. Ronco, P. McCullough, S. Anker [et al.] // Eur. Heart J.- 2010.- Vol. 3. - P. 703-711.Cigarette smoking and progression of IgA nephropathy / R. Yamamoto, Y. Nagasawa, T. Shoji [et al.] // Am J Kidney Dis.- 2010; 56.- P.- 313–324Cigarette smoking and progression of IgA nephropathy / R. Yamamoto, Y. Nagasawa, T. Shoji [et al.] // Am J Kidney Dis.- 2010; 56.- P.- 313–324Despres J.-P. Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk / J.P. Despres // EurHeart J. - 2006; 8 (suppl. B): 4-12.Despres J.-P. Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk / J.P. Despres // EurHeart J. - 2006; 8 (suppl. B): 4-12.ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular In terventions (EAPCI) / S. Windecker, P. Kolh, F. Alfonso [et al.] // Eur. Heart J. – 2014. – Vol. 35, № 37. – P. 619-2541.ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular In terventions (EAPCI) / S. Windecker, P. Kolh, F. Alfonso [et al.] // Eur. Heart J. – 2014. – Vol. 35, № 37. – P. 619-2541.Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury.- Kidney Int. (Suppl). - 2012.- 2:1-138.Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury.- Kidney Int. (Suppl). - 2012.- 2:1-138.Insulin resistance and risk of chronic kidney disease in nondiabetic US adults / J. Chen, P. Muntner, L. Hamm [et al.] // J Am Soc Nephron.- 2003.- V.14.- P. 469-477.Insulin resistance and risk of chronic kidney disease in nondiabetic US adults / J. Chen, P. Muntner, L. Hamm [et al.] // J Am Soc Nephron.- 2003.- V.14.- P. 469-477.Kurella M. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults / M. Kurella, J.C. Lo, G. M. Chertow // J Am Soc Nephrol. 2005.- V.16. – P. 2134-2140.Kurella M. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults / M. Kurella, J.C. Lo, G. M. Chertow // J Am Soc Nephrol. 2005.- V.16. – P. 2134-2140.Lipid metabolism in patients with chronic renal failure / C.E. Urazlina, T.V. Zhdanova, A.V. Nazarov [et al.] // Ural Medical Journal. – 2011. – № 2(80). – Р.6-122.Lipid metabolism in patients with chronic renal failure / C.E. Urazlina, T.V. Zhdanova, A.V. Nazarov [et al.] // Ural Medical Journal. – 2011. – № 2(80). – Р.6-122.Peterson J.C. Blood pressure control, proteinuria, and the progression of renal disease / The Modification of Diet in Renal Disease Study / J.C. Peterson // Ann. Intern. Med. – 1995. – №123. – P.754-762.Peterson J.C. Blood pressure control, proteinuria, and the progression of renal disease / The Modification of Diet in Renal Disease Study / J.C. Peterson // Ann. Intern. Med. – 1995. – №123. – P.754-762.Song-jian H. Role of statins in preventing cardiac surgery-associated acute kidney injury: an updated meta-analysis of randomized controlled trials / H. Song-jian, Liu Qiang, Hua-qiu Li, Fang Tian, Shi-yu Chen // TherClin Risk Manag. – 2018. V.14. - P.475–482Song-jian H. Role of statins in preventing cardiac surgery-associated acute kidney injury: an updated meta-analysis of randomized controlled trials / H. Song-jian, Liu Qiang, Hua-qiu Li, Fang Tian, Shi-yu Chen // TherClin Risk Manag. – 2018. V.14. - P.475–482

The authors declare that there are no conflicts of interest present.