Многофакторный анализ причин острого почечного повреждения после паратиреоидэктомии по поводу первичного гиперпаратиреоза. / Parshina, E. V.; Zulkarnaev, A. B.; Mikhaylova, S. S.; Kislyy, P. N.; Chernikov, R. A.
In: Nephrology and Dialysis, Vol. 22, No. 3, 2020, p. 372-382.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Многофакторный анализ причин острого почечного повреждения после паратиреоидэктомии по поводу первичного гиперпаратиреоза
AU - Parshina, E. V.
AU - Zulkarnaev, A. B.
AU - Mikhaylova, S. S.
AU - Kislyy, P. N.
AU - Chernikov, R. A.
N1 - Publisher Copyright: © 2020 JSC Vidal Rus. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Aim: to conduct multivariate analysis of the risk factors for the development of postoperative acute kidney injury (AKI) after surgery for primary hyperparathyroidism (PHPT). Materials and methods: we performed a retrospective cohort study of 290 patients who underwent successful selective parathyroidectomy (PTx) for PHPT for the first time. AKI was defined according to KDIGO 2012 criteria. Results: the incidence of AKI in our cohort was 36.6%. We have grouped the risk factors as follows. Among the comorbid conditions, significant risk factors were age (ОR 1.05 [95%CI 1.02; 1.08] per a year, р=0.002), BMI (ОR 1.07 [95%CI 1.02; 1.13] per each kg/m2, р=0.005), anemia (yes/no ОR 3.38 [95%CI 1.38; 8.2], р=0.008), but not diabetes (yes/no ОR 0.96 [95%CI 0.42; 2.2], р=0.959), hypertension (yes/no ОR 1.29 [95%CI 0.62; 2.69], р=0.492), chronic kidney disease (yes/no ОR 1.06 [95%CI 0.5; 2.23], р=0.88). Among the PHPT-associated conditions, significant factors were: a history of fractures (yes/no ОR 5.6 [95%CI 1.4; 22.4], р=0.0015), bone mineral density value (BMD) (ОR 1.9 [95%CI 1.19; 3.03] per each SD, р=0.007). Among the "renal" risk factors – proteinuria (yes/no ОR 4.31 [95%CI 1.64; 11.35], р=0.003), eGFR (ОR 1.02 [95%CI 1.0; 1.03] per each ml/min/1.73 m2, р=0.042), use of ACE inhibitors/ARBs (ОR 2.84 [95%CI 1.58; 5.12], р=0.001), use of diuretics (ОR 2.23 [95%CI 1.11; 4.44], р=0.023), but not calcium channel blockers (ОR 1.75 [95%CI 0.88; 3.48], р=0.11), significantly increased risk of AKI. Intraoperative hypotension, minimal mean arterial pressure and hypotension duration did not increase the risk of AKI (р=0.945, 0.883 and 0.865, respectively). Among the specific PHPT-associated risk factors, significant were preoperative PTH level (ОR 1.03 [95%CI 1.01; 1.05] per each pmol/l, р=0.002), ∆ PTH (ОR 1.03 [95%CI 1.01; 1.06] per each pmol/l, р=0.003), but not preoperative serum ionized calcium level (ОR 0.4 [95%CI 0.06; 2.56] per each mmol/l, р=0.337) as well as the severity of its decrease (ОR 0.35 [95%CI 0.04; 3.53] per each mmol/l, р=0.352). Conclusions: the high risk of AKI after PTx for PHPT should be taken into account, risk factors of this complication should be identified and considered when planning PTx, special attention should be paid to modifiable risk factors: BMI, anemia, use of ACE inhibitors/ARBs, preoperative PTH level.
AB - Aim: to conduct multivariate analysis of the risk factors for the development of postoperative acute kidney injury (AKI) after surgery for primary hyperparathyroidism (PHPT). Materials and methods: we performed a retrospective cohort study of 290 patients who underwent successful selective parathyroidectomy (PTx) for PHPT for the first time. AKI was defined according to KDIGO 2012 criteria. Results: the incidence of AKI in our cohort was 36.6%. We have grouped the risk factors as follows. Among the comorbid conditions, significant risk factors were age (ОR 1.05 [95%CI 1.02; 1.08] per a year, р=0.002), BMI (ОR 1.07 [95%CI 1.02; 1.13] per each kg/m2, р=0.005), anemia (yes/no ОR 3.38 [95%CI 1.38; 8.2], р=0.008), but not diabetes (yes/no ОR 0.96 [95%CI 0.42; 2.2], р=0.959), hypertension (yes/no ОR 1.29 [95%CI 0.62; 2.69], р=0.492), chronic kidney disease (yes/no ОR 1.06 [95%CI 0.5; 2.23], р=0.88). Among the PHPT-associated conditions, significant factors were: a history of fractures (yes/no ОR 5.6 [95%CI 1.4; 22.4], р=0.0015), bone mineral density value (BMD) (ОR 1.9 [95%CI 1.19; 3.03] per each SD, р=0.007). Among the "renal" risk factors – proteinuria (yes/no ОR 4.31 [95%CI 1.64; 11.35], р=0.003), eGFR (ОR 1.02 [95%CI 1.0; 1.03] per each ml/min/1.73 m2, р=0.042), use of ACE inhibitors/ARBs (ОR 2.84 [95%CI 1.58; 5.12], р=0.001), use of diuretics (ОR 2.23 [95%CI 1.11; 4.44], р=0.023), but not calcium channel blockers (ОR 1.75 [95%CI 0.88; 3.48], р=0.11), significantly increased risk of AKI. Intraoperative hypotension, minimal mean arterial pressure and hypotension duration did not increase the risk of AKI (р=0.945, 0.883 and 0.865, respectively). Among the specific PHPT-associated risk factors, significant were preoperative PTH level (ОR 1.03 [95%CI 1.01; 1.05] per each pmol/l, р=0.002), ∆ PTH (ОR 1.03 [95%CI 1.01; 1.06] per each pmol/l, р=0.003), but not preoperative serum ionized calcium level (ОR 0.4 [95%CI 0.06; 2.56] per each mmol/l, р=0.337) as well as the severity of its decrease (ОR 0.35 [95%CI 0.04; 3.53] per each mmol/l, р=0.352). Conclusions: the high risk of AKI after PTx for PHPT should be taken into account, risk factors of this complication should be identified and considered when planning PTx, special attention should be paid to modifiable risk factors: BMI, anemia, use of ACE inhibitors/ARBs, preoperative PTH level.
KW - Acute kidney injury
KW - Calcium
KW - Parathyroid hormone
KW - Parathyroidectomy
KW - Primary hyperparathyroidism
UR - http://www.scopus.com/inward/record.url?scp=85093501932&partnerID=8YFLogxK
U2 - 10.28996/2618-9801-2020-3-372-382
DO - 10.28996/2618-9801-2020-3-372-382
M3 - статья
AN - SCOPUS:85093501932
VL - 22
SP - 372
EP - 382
JO - Nephrology and Dialysis
JF - Nephrology and Dialysis
SN - 1680-4422
IS - 3
ER -
ID: 93661005