cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.n466cardio-466Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESОценка риска развития острого повреждения почек у больных с острой сердечно-сосудистой патологией без инвазивного вмешательстваRisk assessment of acute kidney injury in patients with acute cardiovascular disease without invasive interventionАвдошинаС. В.AvdoshinaS. V.

117198, г. Москва, ул. Миклухо-Маклая, д. 8

Miklukho-Maklay st., 8, Moscow 117198

savdoshina@gmail.comЕфремовцеваМ. А.EfremovtsevaM. A.

117198, г. Москва, ул. Миклухо-Маклая, д. 8

Miklukho-Maklay st., 8, Moscow 117198

marinaef56@mail.ruВиллевальдеС. В.VillevaldeS. V.

117198, г. Москва, ул. Миклухо-Маклая, д. 8

Miklukho-Maklay st., 8, Moscow 117198

villevaldes@mail.ruКобалаваЖ. Д.KobalavaZh. D.

117198, г. Москва, ул. Миклухо-Маклая, д. 8

Miklukho-Maklay st., 8, Moscow 117198

kobalava_zhd@pfur.ruФГАОУ ВО «Российский университет дружбы народов», Медицинский институтРоссияFederal state autonomous educational institution of higher education “Peoples’ friendship University of Russia”, Medical InstituteRussian Federation2019011120195912S4656Copyright © Kardiomag, 20202020KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/466

Цель. Оценить распространенность, выявить варианты и детерминанты развития, прогностическую значимость кардиоренальных взаимодействий у больных с острыми сердечно-сосудистыми заболеваниями (ССЗ), а также разработать алгоритм стратификации этих больных по риску развития острого повреждения почек (ОПП). Материалы и методы. В исследование включены 566 пациентов: 278 – с острой декомпенсацией сердечной недостаточности (ОДСН) и 288 – с острым коронарным синдромом без подъема сегмента ST (ОКСбпST) с консервативной тактикой ведения. Определены уровни электролитов, глюкозы, мочевины, креатинина, скорости клубочковой фильтрации (СКФ) по формуле CKD-EPI, выполнены рентгенография органов грудной клетки, электрокардиография при поступлении и в динамике, эхокардиография при поступлении с оценкой систолической и диастолической функций миокарда. Хроническую болезнь почек (ХБП), ОПП, ОДСН, ОКСбпST диагностировали на основании российских и международных рекомендаций. Различия средних величин и корреляционные связи считались достоверными при уровне значимости p<0,05. Результаты. Различные варианты кардиоренальных взаимодействий выявлены у 366 (64,7%) пациентов. ХБП присутствовала у 259 (45,8%) человек, при этом более чем в половине случаев (61%) она была впервые диагностирована при данной госпитализации, у 62 (11%) больных имелись признаки повреждения почек неизвестной давности (что не позволяло диагностировать ХБП). ОПП развилось у 228 (40,3%) больных, несколько чаще оно встречалось при ОДСН, чем при ОКСбпST (43,5 и 37,2%). Во всех группах преобладала 1-я стадия ОПП. Внутрибольничная летальность у пациентов с острыми ССЗ была значительно выше при развитии ОПП (14,9 и 3,6%, p<0,001). Определены предикторы развития ОПП. Риск развития ОПП определялся функциональным состоянием почек и уровнем артериального давления (АД) при поступлении, сопутствующей патологией. Заключение. Распространенность кардиоренальных взаимодействий у пациентов с острыми ССЗ (ОДСН и ОКСбпST с консервативной тактикой ведения) составила 64,7%, развитие ОПП значительно ухудшало прогноз больных в обеих группах. С наибольшим риском развития ОПП ассоциированы уровень АД и функциональное состояние почек при поступлении.

Objective. To evaluate the prevalence, predictors, prognostic value of cardiorenal interrelations in patients with acute cardiovascular disease (CVD), and to develop an algorithm for stratification these patients at risk of acute kidney injury (AKI). Materials and methods. 566 patients (pts) were examined: 278 with acute decompensated heart failure (ADHF) and 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS). The levels of electrolytes, glucose, urea, creatinine were evaluated, glomerular filtration rate (GFR) was determined according to the formula CKD-EPI. Chest x-ray, electrocardiography at admission and in dynamics, echocardiography at admission with assessment of systolic and diastolic myocardial functions were performed. Chronic kidney disease (CKD), AKI, ADHF, NSTE-ACS were diagnosed according to Russian and international Guidelines. Mann-Whitney test and multivariate logistic regression analysis were considered significant if p<0.05. Results. Different variants of cardiorenal interrelations were revealed in 366 (64.7%) pts. CKD was diagnosed in 259 (45.8%), with more than half of the cases (61%) diagnosed for the first time at this hospitalization, 62 (11%) pts had signs of kidney damage of unknown duration (which did not allow to diagnose CKD). AKI occurred in 228 (40,3%) pts, more frequently in patients with ADHF vs with NSTE-ACS (43.5 and 37.2%). In all groups stage 1 of AKI was prevalent. In-hospital mortality was significantly higher in pts with AKI vs without AKI (14.9 vs 3.6%, p<0.001). The risk of AKI was determined by kidney function and blood pressure levels at admission, and comorbidities. Conclusion. Prevalence of cardiorenal interactions in patients with acute CVD (ADHF and NSTE-ACS) was 64.7%. Development of AKI was associated with poor prognosis in both groups. Renal function and blood pressure levels on admission are the main predictors of AKI.

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