ポンプオフまたはポンプオンによる冠動脈バイパス移植手術後の腎機能:ランダム化臨床試験
Amit X Garg1, P J Devereaux2, Salim Yusuf2
1Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada2Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada3Department of Clinical Epidemiology and Biostatistics, McMaster Universit.
JAMA
|June 3, 2014
まとめ
ポンプ外冠動脈バイパス移植 (CABG) 手術により,急性腎臓損傷のリスクが低下しました. しかし,この介入は,CABG手術を受けた患者の1年後の長期腎機能を改善しませんでした.
科学分野:
- ネフロロジーと心血管外科
- 心臓の手術後の腎臓機能の調査
- 入院患者における急性腎損傷 (AKI) の理解
背景:
- 病院で得られた急性腎臓損傷 (AKI) は一般的であり,長期的な腎臓機能の低下に関連しています.
- AKIのリスクを低減する介入は,腎臓の機能を長期的に保つのが証明されていない.
- 冠動脈バイパス移植手術オフまたはオンポンプ再循環化研究 (CORONARY) は,この関係を調査しました.
研究 の 目的:
- 異なるテクニックを使用して,冠動脈バイパス移植 (CABG) 手術を受ける患者のAKIのリスクを評価する.
- オフポンプとオンポンプのCABGグループ間の手術後1年の腎臓機能の比較.
- AKIのリスクを減らすことが,腎臓機能の長期保存に影響するかどうかを判断する.
主な方法:
- ランダム化臨床試験 (CORONARY) で,孤立したCABG手術を受けた4752人の患者が参加した.
- 患者はランダムに抽出され,ポンプ外 (鼓動する心臓) またはポンプ内 (心肺バイパス) のCABGに割り当てられました.
- 腎機能サブスタディ (2932人の患者) では,血清クレアチニンと推定グルメルフィルタレーション率 (eGFR) を手術後および1年後に追跡した.
主要な成果:
- ポンプ外CABG手術は30日以内に急性腎臓損傷のリスクを大幅に低下させました (17.5% vs 20.8%; RR, 0.83; P=.01).
- 1年後の腎機能低下の有意な違いは,ポンプ外とポンプ内グループ (17.1% vs 15.3%; RR, 1.10; P=.23) 間で観察されなかった.
- 結果は,さまざまなAKIおよび腎機能低下の定義,および既にある慢性腎疾患を有する患者の間で一貫したままでした.
結論:
- オフポンプCABG手術は,手術後の急性腎臓損傷のリスクを効果的に低下させます.
- AKIのリスクを低減したにもかかわらず,オフポンプCABGは1年後に腎臓機能の保全の改善を示さなかった.
- 軽度から中等度のAKIリスクを低下させる介入は,長期的な腎臓機能の結果を必ずしも変化させる必要はありません.
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