儿科连续流动心室辅助装置患者的长期结局
Alexandra Idrovo1,2, Seth A Hollander3, Tara M Neumayr4,5
1Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's, Houston, TX, USA. Alexandra.Idrovo@UTSouthwestern.edu.
Pediatric nephrology (Berlin, Germany)
|November 16, 2023
概括
连续流动心室辅助装置 (CF-VADs) 的儿科患者经常发展或恶化慢性病 (CKD). 预先存在的CKD和急性损伤 (AKI) 会增加死亡风险,强调需要主动监测脏.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗器械 医疗器械
背景情况:
- 持续流动的心室辅助器件 (CF-VAD) 越来越多地用于儿科末期心力衰竭 (ESHF).
- 来自CF-VAD的非脉动性流动对脏造成独特的循环应激,可能导致急性损伤 (AKI) 和慢性病 (CKD).
- 儿童CF-VAD患者慢性病进展的长期结局和风险因素尚不清楚.
研究的目的:
- 为了研究儿童患者的长期结局,儿童患者接受了90天以上的CF-VAD治疗.
- 在长期CF-VAD支持期间识别 de novo CKD的发病率和先前存在的CKD的进展.
- 确定与CKD结局和这一群体的死亡率相关的因素.
主要方法:
- 一项多中心研究分析了134名儿科ESHF患者的CF-VAD支持>90天 (2008-2018).
- 主要结局是根据KDIGO标准定义的CKD;次要结局包括AKI发病率和3-12个月后CKD演变.
- 统计分析探讨了各种因素 (病因,ECMO,CF-VAD持续时间,AKI历史,RRT) 和CKD结果之间的关联.
主要成果:
- 在134名患者中,54%的患者先前患有CKD,63%的患者经历过AKI. 3个月后,14%的人出现了新的CKD,49%的CKD持续或恶化.
- 在心力衰竭病因,ECMO使用,CF-VAD持续时间,AKI史,或RRT和CKD结果之间没有发现显著的关联.
- 在有AKI史或先前存在CKD的患者中,死亡率更高.
结论:
- 植入前CKD和植入前AKI在儿科CF-VAD患者中很常见.
- 长期的CF-VAD支持可以导致新的CKD或恶化现有的CKD.
- 积极的功能监测和有针对性的随访对于优化儿科CF-VAD接受者的结果至关重要.
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