ABSTRACT
The problem of kidney dysfunction and its impact on outcomes in different groups of cardiac patients continue to being widely used. Kidney dysfunction is associated with a number of traditional cardiovascular risk factors. The use of new biomarkers, cystatin C in particular, to identify kidney injury can contribute to the improvement of early prediction of a risk for renal failure (RF). Cystatin C satisfies many characteristics as an ideal biomarker that can assist in not only detecting the early forms of kidney injury, but also in assessing the risk of RF, the needs for renal replacement therapy, and the risk of death in intensive care unit patients in cardiac clinics. Kidney involvement in many diseases, including those that are not initially regarded as renal, necessitates the elaboration of uniform approaches to managing patients with identified chronic RF, especially to the early prevention and treatment of its complications, such as anemia, phosphorus-calcium metabolic disorders, which substantially worsen the prognosis of other diseases.
Subject(s)
Biomarkers , Coronary Artery Disease/diagnosis , Kidney Diseases/diagnosis , Kidney Diseases/physiopathology , Coronary Artery Disease/complications , Early Diagnosis , Humans , Kidney Diseases/etiologyABSTRACT
AIM: To assess value of kidney injury molecule-1 (KIM-1) for prediction of inhospital events in CAD patients undergoing coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS: We analyzed postoperative course of 719 patients subjected to CABG in Research Institute for Complex Issues of Cardiovascular Diseases between March, 2011 and April, 2012. In all patients we measured creatinine concentrations, glomerular filtration rate (GFR) by MDRD and urine KIM-1 levels before and on day 7 after CABG. Major unfavorable events (myocardial infarction, stroke or transient ischemic attack, acute or decompensated chronic renal failure or remediastinotomy) were registered during hospital stay. The EuroSCORE (European System for Cardiac Operative Risk Evaluation) risk of operative mortality was calculated for each patient. RESULTS: Patients with different EuroSCORE risk had similar serum creatinine levels while KIM-1 concentrations in urine were significantly higher in patients with moderate and high EuroSCORE risk as compared with low-risk patients. Patients who experienced postoperative events had significantly higher KIM-1 both before and after surgery while there were no differences in such renal dysfunction markers as creatinine and GFR. CONCLUSION: Preoperative elevated KIM-1 can act as a marker of complicated postoperative period after CABG.
Subject(s)
Coronary Artery Bypass/adverse effects , Membrane Glycoproteins/urine , Myocardial Ischemia , Postoperative Complications , Renal Insufficiency , Stroke , Biomarkers/urine , Coronary Artery Bypass/methods , Coronary Artery Bypass/mortality , Female , Hepatitis A Virus Cellular Receptor 1 , Humans , Kidney Function Tests/methods , Male , Middle Aged , Myocardial Ischemia/epidemiology , Myocardial Ischemia/metabolism , Myocardial Ischemia/surgery , Outcome Assessment, Health Care , Postoperative Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/metabolism , Postoperative Complications/surgery , Predictive Value of Tests , Preoperative Care/methods , Receptors, Virus , Renal Insufficiency/diagnosis , Renal Insufficiency/etiology , Renal Insufficiency/metabolism , Reoperation/statistics & numerical data , Retrospective Studies , Risk Assessment/methods , Risk Factors , Siberia , Stroke/diagnosis , Stroke/etiology , Stroke/metabolismABSTRACT
AIM: To identify predictors of contrast-induced nephropathy (CIN) and evaluate its significance for the hospital prognosis of myocardial infarction with elevated ST segment. MATERIALS AND METHODS: 722 (75.7%) of the total 954 patients underwent X ray examination with the use of contrast material (coronary angiography (CAG) and/or transcutaneous coronary intervention (TCI)) within 24 hr after the appearance of symptoms. In all cases, serum creatinine level was determined and glomerular filtration rate (GFR) calculated by the MDRD formula at admission, 2-3 days after CAG/TCI, and 10-14 days after hospitalization. CIN was defined as a more than 25% (44 mcmnol/l) rise in the creatinine level compared with the initial one within 48-72 hr after intravascular administration of contrast material in the absence of an alternative cause. The endpoints (adverse cardiovascular effects) were evaluated at the hospital stage of the study. RESULTS: Significantly more patients with CIN (n=52; 7.2%) had the history ofdiabetes mellitus (DM) and chronic renal disease (CRD), clinically manifest Killip class II-IV acute cardiac failure (ACF), and reduced left ventricular ejection fraction (LVEF) compared with the patients having normal renal function. The risk of RAEF in the presence of CIN increased by 2.5 times (95% CI 1.26-5.05), that of MI by 5.4% (95% CI 2.69-10.64), life-threatening and other complications by 4.1% (95% CI 1.99-8.29) and 5.1% (95% CI times 2.85-9.17) times respectively. The presence of Killip class II-IV ACF increased the risk of CIN and DM by afactor of 2.2. CONCLUSION: CIN was diagnosed in 7.2% of the patients with myocardial infarction and elevated ST segment; it is associated with the history of DM, CRD, pronounced Killip class II-IV ACF and decreased LVEF DM and clinically manifest ACF were independent predictors of CIN in patients with myocardial infarction and elevated ST segment.
