التفاصيل البيبلوغرافية
| العنوان: |
Kinetic Changes of Plasma Renin Concentrations Predict Acute Kidney Injury in Cardiac Surgery Patients. |
| المؤلفون: |
Küllmar, Mira, Saadat-Gilani, Khaschayar, Weiss, Raphael, Massoth, Christina, Lagan, Anas, Cortés, Manuel Núñez, Gerss, Joachim, Chawla, Lakhmir S., Fliser, Danilo, Meersch, Melanie, Zarbock, Alexander |
| المصدر: |
American Journal of Respiratory & Critical Care Medicine; 5/1/2021, Vol. 203 Issue 9, p1119-1126, 20p |
| مصطلحات موضوعية: |
RENIN-angiotensin system, ALDOSTERONE, ACUTE kidney failure, CARDIAC surgery patients, CARDIAC surgery risk factors, CARDIAC surgery, RENIN, LENGTH of stay in hospitals, RESEARCH, PREDICTIVE tests, RESEARCH methodology, SURGICAL complications, MEDICAL cooperation, EVALUATION research, COMPARATIVE studies, HYPOTENSION, RECEIVER operating characteristic curves, CARDIOPULMONARY bypass, LONGITUDINAL method |
| مستخلص: |
Rationale: The renin-angiotensin-aldosterone system is a major pathway in regulating blood pressure, glomerular filtration, and fluid homeostasis. During inflammatory diseases, generation of angiotensin II might be disturbed, leading to increased renin concentrations. Cardiac surgery and the use of cardiopulmonary bypass both induce inflammatory response and cardiovascular instability, which can contribute to acute kidney injury (AKI).Objectives: To investigate whether renin concentrations are associated with hypotension and AKI.Methods: This is a single-center, prospective, observational study among patients undergoing cardiac surgery.Measurements and Main Results: The primary endpoint was the occurrence of AKI within 72 hours after cardiac surgery. A total of 197 patients were available for the primary analysis. The median renin serum concentration was 40.2 μU/ml (quartile 1 [Q1]-Q3, 9.3-144.4) at baseline and 51.3 μU/ml (Q1-Q3, 19.1-167.0) 4 hours after cardiac surgery, whereas the difference between postoperation and preoperation concentrations (Δ-renin) was 3.7 μU/ml (Q1-Q3, -22.7 to 50.9). Patients with an elevated Δ-renin developed an AKI significantly more often (43% vs. 12.2%; P < 0.001). High Δ-renin after cardiac surgery was associated with a significantly lower mean arterial pressure, longer time on vasopressors, and longer length of ICU and hospital stay. The area under the curve (AUC) of Δ-renin for the prediction of AKI (AUC, 0.817; 95% confidence interval, 0.747-0.887) was significantly greater compared with the AUC of the postoperative renin concentrations (AUC, 0.702; 95% CI, 0.610-0.793; P = 0.007).Conclusions: Elevated renin concentrations were associated with cardiovascular instability and increased AKI after cardiac surgery. Elevated renin concentrations could be used to identify high-risk patients for cardiovascular instability and AKI who would benefit from timely intervention that could improve their outcomes. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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