Lesão renal aguda após cirurgia cardíaca
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da FAMERP |
Texto Completo: | http://bdtd.famerp.br/handle/tede/291 |
Resumo: | Introduction: Acute kidney injury is a complex syndrome characterized by rapid (hours or days) reduction in renal excretion that occurs in a wide variety of situations. It has wide variability of epidemiology and is a common complication in critically ill and intensive care patients. Acute kidney injury generate increased hospital costs and is associated with high mortality rates being independent predictor of death. Currently, three diagnostic criteria for acute kidney injury has been highlighted: RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease), AKIN (Acute Kidney Injury Network) and KDIGO (Kidney Disease: Improving Global Outcomes). Objectives: To evaluate the incidence, morbidity and mortality associated with acute kidney injury (and its value as a predictor of 30-day mortality) in patients undergoing on-pump coronary artery bypass grafting (article 1), patients undergoing cardiac valve surgery (article 2), patients with elevated preoperative baseline creatinine (article 3) and, in general, in patients undergoing cardiac surgery (coronary artery bypass grafting or cardiac valve surgery) (article 4). Methods: (Article 1) Patients undergoing on-pump CABG from January 2003 to January 2008 (817 patients) were divided according to the AKIN classification in AKI (+) and AKI (-) patients. Multivariable logistic regression was used to determine independent predictors of 30-day mortality. (Article 2) Patients undergoing cardiac valve surgery from January 2003 to May 2010 (837 patients) were divided according to the presence of infective endocarditis. Cox regression analysis was used to determine independent predictors of 30-day mortality. (Article 3) Patients with elevated baseline serum creatinine underwent cardiac surgery (CABG or CVS) from January 2003 to June 2013 (918 patients) were evaluated to determine whether the development of post-operative acute kidney injury based on KDIGO criteria was an independent predictor of 30-day mortality. (Article 4) Patients undergoing cardiac surgery (CABG or CVS) between January 2003 and June 2013 (2804 patients) were evaluated to determine if acute kidney injury based on KDIGO criteria was an independent predictor of 30-day mortality. Results: (all articles) Patients who developed AKI postoperatively had more clinical complications. The 30-day mortality increased progressively in all stages of acute kidney injury. Based on AKIN and KDIGO criteria, AKI was an independent predictor of 30-day mortality. Conclusions: (all articles) In this population, acute kidney injury after cardiac surgery was an independent predictor of 30-day mortality. |
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Maia, Lília NigroBraile, Domingo MarcolinoBurdmann, Emmanuel de AlmeidaPiegas, Leopoldo SoaresRamos, Rui Fernando42653266172http://lattes.cnpq.br/6764701625517296Machado, Maurício de Nassau2016-09-15T18:30:05Z2014-05-07Machado, Maurício de Nassau. Lesão renal aguda após cirurgia cardíaca. 2014. 65 p. Tese (Programa de Pós-graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto.1189http://bdtd.famerp.br/handle/tede/291Introduction: Acute kidney injury is a complex syndrome characterized by rapid (hours or days) reduction in renal excretion that occurs in a wide variety of situations. It has wide variability of epidemiology and is a common complication in critically ill and intensive care patients. Acute kidney injury generate increased hospital costs and is associated with high mortality rates being independent predictor of death. Currently, three diagnostic criteria for acute kidney injury has been highlighted: RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease), AKIN (Acute Kidney Injury Network) and KDIGO (Kidney Disease: Improving Global Outcomes). Objectives: To evaluate the incidence, morbidity and mortality associated with acute kidney injury (and its value as a predictor of 30-day mortality) in patients undergoing on-pump coronary artery bypass grafting (article 1), patients undergoing cardiac valve surgery (article 2), patients with elevated preoperative baseline creatinine (article 3) and, in general, in patients undergoing cardiac surgery (coronary artery bypass grafting or cardiac valve surgery) (article 4). Methods: (Article 1) Patients undergoing on-pump CABG from January 2003 to January 2008 (817 patients) were divided according to the AKIN classification in AKI (+) and AKI (-) patients. Multivariable logistic regression was used to determine independent predictors of 30-day mortality. (Article 2) Patients undergoing cardiac valve surgery from January 2003 to May 2010 (837 patients) were divided according to the presence of infective endocarditis. Cox regression analysis was used to determine independent predictors of 30-day mortality. (Article 3) Patients with elevated baseline serum creatinine underwent cardiac surgery (CABG or CVS) from January 2003 to June 2013 (918 patients) were evaluated to determine whether the development of post-operative acute kidney injury based on KDIGO criteria was an independent predictor of 30-day mortality. (Article 4) Patients undergoing cardiac surgery (CABG or CVS) between January 2003 and June 2013 (2804 patients) were evaluated to determine if acute kidney injury based on KDIGO criteria was an independent predictor of 30-day mortality. Results: (all articles) Patients who developed AKI postoperatively had more clinical complications. The 30-day mortality increased progressively in all stages of acute kidney injury. Based on AKIN and KDIGO criteria, AKI was an independent predictor of 30-day mortality. Conclusions: (all articles) In this population, acute kidney injury after cardiac surgery was an independent predictor of 30-day mortality.Introdução: Disfunção renal aguda é uma síndrome complexa caracterizada pela rápida (horas ou dias) redução da excreção renal que ocorre em uma grande variedade de situações. Ela tem ampla variabilidade epidemiológica e é complicação comum em pacientes gravemente enfermos e de terapia intensiva gerando aumento dos custos hospitalares e associando-se a altas taxas mortalidade sendo preditor independente do risco de morte. Atualmente, três critérios diagnósticos para lesão renal aguda tem se destacado: RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease), AKIN (Acute Kidney Injury Network) e KDIGO (Kidney Disease: Improving Global Outcomes). Objetivos: Avaliar a incidência, morbidade e mortalidade associada a lesão renal aguda (e seu valor como preditor de óbito em 30 dias) em pacientes submetidos a cirurgia de revascularização do miocárdio com CEC, pacientes submetidos a cirurgia valvar, pacientes com creatinina basal elevada no pré-operatório e, de maneira global, em pacientes submetidos a cirurgia cardíaca (revascularização do miocárdio ou cirurgia valvar). Métodos: (artigo 1) Pacientes submetidos a RM com CEC no período de janeiro de 2003 a janeiro de 2008 (817 pacientes) foram divididos de acordo com a classificação AKIN em LRA (+) e LRA (-). Regressão logística multivariada foi utilizada para determinação de preditores independentes para óbito em 30 dias; (artigo 2) Pacientes submetidos a cirurgia valvar no período de janeiro de 2003 a maio de 2010 (837 pacientes) foram divididos de acordo com a presença de endocardite infecciosa. Regressão de Cox foi usada para determinar preditores independentes para óbito em 30 dias; (artigo 3) Pacientes portadores de creatinina basal elevada (pré-operatório) submetidos a cirurgia cardíaca (RM ou CV) entre janeiro de 2003 a junho de 2013 (918 pacientes) foram avaliados para determinar se o desenvolvimento de lesão renal aguda pós-operatória baseada nos critérios KDIGO foi preditor independente de óbito em 30 dias; (artigo 4) Pacientes submetidos a cirurgia cardíaca (RM ou CV) entre janeiro de 2003 a junho de 2013 (2804 pacientes) foram avaliados para determinar se o desenvolvimento de lesão renal aguda pós-operatória baseada nos critérios KDIGO foi preditor independente de óbito em 30 dias. Resultados: (todos artigos) Pacientes que evoluíram com LRA tiveram mais complicações no pós-operatório. A mortalidade em 30 dias aumentou progressivamente em todos os estágios de lesão renal aguda. Baseado nos critérios AKIN e KDIGO, LRA foi preditor independente de óbito em 30 dias. Conclusões: (todos artigos) Na população estudada, alteração aguda da função renal no pós-operatório foi preditor independente de óbito em 30 dias.Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2016-09-15T18:30:05Z No. of bitstreams: 1 mauriciodenassaumachado_tese.pdf: 15169790 bytes, checksum: 44c4bba3d0bddeb188ec239527b863f1 (MD5)Made available in DSpace on 2016-09-15T18:30:05Z (GMT). No. of bitstreams: 1 mauriciodenassaumachado_tese.pdf: 15169790 bytes, checksum: 44c4bba3d0bddeb188ec239527b863f1 (MD5) Previous issue date: 2014-05-07application/pdfporFaculdade de Medicina de São José do Rio PretoPrograma de Pós-Graduação em Ciências da Saúde::1102159680310750095::500FAMERPBrasilFaculdade 1::Departamento 1::306626487509624506::500Acute Kidney InjuryThoracic SurgeryMyocardial RevascularizationMorbidityMortalityLesão renal agudaCirurgia TorácicaRevascularização miocárdicaMorbidadeMortalidadeCIENCIAS DA SAUDE::8765449414823306929::600Lesão renal aguda após cirurgia cardíacainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da FAMERPinstname:Faculdade de Medicina de São José do Rio Preto (FAMERP)instacron:FAMERPLICENSElicense.txtlicense.txttext/plain; charset=utf-82165bd3efa91386c1718a7f26a329fdcb468MD51ORIGINALmauriciodenassaumachado_tese.pdfmauriciodenassaumachado_tese.pdfapplication/pdf1516979044c4bba3d0bddeb188ec239527b863f1MD52http://bdtd.famerp.br/bitstream/tede/291/1/license.txthttp://bdtd.famerp.br/bitstream/tede/291/2/mauriciodenassaumachado_tese.pdftede/2912019-02-04 11:06:04.837oai:localhost:tede/291Tk9UQTogQ09MT1FVRSBBUVVJIEEgU1VBIFBSw5NQUklBIExJQ0VOw4dBCkVzdGEgbGljZW7Dp2EgZGUgZXhlbXBsbyDDqSBmb3JuZWNpZGEgYXBlbmFzIHBhcmEgZmlucyBpbmZvcm1hdGl2b3MuCgpMSUNFTsOHQSBERSBESVNUUklCVUnDh8ODTyBOw4NPLUVYQ0xVU0lWQQoKQ29tIGEgYXByZXNlbnRhw6fDo28gZGVzdGEgbGljZW7Dp2EsIHZvY8OqIChvIGF1dG9yIChlcykgb3UgbyB0aXR1bGFyIGRvcyBkaXJlaXRvcyBkZSBhdXRvcikgY29uY2VkZSDDoCBVbml2ZXJzaWRhZGUgClhYWCAoU2lnbGEgZGEgVW5pdmVyc2lkYWRlKSBvIGRpcmVpdG8gbsOjby1leGNsdXNpdm8gZGUgcmVwcm9kdXppciwgIHRyYWR1emlyIChjb25mb3JtZSBkZWZpbmlkbyBhYmFpeG8pLCBlL291IApkaXN0cmlidWlyIGEgc3VhIHRlc2Ugb3UgZGlzc2VydGHDp8OjbyAoaW5jbHVpbmRvIG8gcmVzdW1vKSBwb3IgdG9kbyBvIG11bmRvIG5vIGZvcm1hdG8gaW1wcmVzc28gZSBlbGV0csO0bmljbyBlIAplbSBxdWFscXVlciBtZWlvLCBpbmNsdWluZG8gb3MgZm9ybWF0b3Mgw6F1ZGlvIG91IHbDrWRlby4KClZvY8OqIGNvbmNvcmRhIHF1ZSBhIFNpZ2xhIGRlIFVuaXZlcnNpZGFkZSBwb2RlLCBzZW0gYWx0ZXJhciBvIGNvbnRlw7pkbywgdHJhbnNwb3IgYSBzdWEgdGVzZSBvdSBkaXNzZXJ0YcOnw6NvIApwYXJhIHF1YWxxdWVyIG1laW8gb3UgZm9ybWF0byBwYXJhIGZpbnMgZGUgcHJlc2VydmHDp8Ojby4KClZvY8OqIHRhbWLDqW0gY29uY29yZGEgcXVlIGEgU2lnbGEgZGUgVW5pdmVyc2lkYWRlIHBvZGUgbWFudGVyIG1haXMgZGUgdW1hIGPDs3BpYSBhIHN1YSB0ZXNlIG91IApkaXNzZXJ0YcOnw6NvIHBhcmEgZmlucyBkZSBzZWd1cmFuw6dhLCBiYWNrLXVwIGUgcHJlc2VydmHDp8Ojby4KClZvY8OqIGRlY2xhcmEgcXVlIGEgc3VhIHRlc2Ugb3UgZGlzc2VydGHDp8OjbyDDqSBvcmlnaW5hbCBlIHF1ZSB2b2PDqiB0ZW0gbyBwb2RlciBkZSBjb25jZWRlciBvcyBkaXJlaXRvcyBjb250aWRvcyAKbmVzdGEgbGljZW7Dp2EuIFZvY8OqIHRhbWLDqW0gZGVjbGFyYSBxdWUgbyBkZXDDs3NpdG8gZGEgc3VhIHRlc2Ugb3UgZGlzc2VydGHDp8OjbyBuw6NvLCBxdWUgc2VqYSBkZSBzZXUgCmNvbmhlY2ltZW50bywgaW5mcmluZ2UgZGlyZWl0b3MgYXV0b3JhaXMgZGUgbmluZ3XDqW0uCgpDYXNvIGEgc3VhIHRlc2Ugb3UgZGlzc2VydGHDp8OjbyBjb250ZW5oYSBtYXRlcmlhbCBxdWUgdm9jw6ogbsOjbyBwb3NzdWkgYSB0aXR1bGFyaWRhZGUgZG9zIGRpcmVpdG9zIGF1dG9yYWlzLCB2b2PDqiAKZGVjbGFyYSBxdWUgb2J0ZXZlIGEgcGVybWlzc8OjbyBpcnJlc3RyaXRhIGRvIGRldGVudG9yIGRvcyBkaXJlaXRvcyBhdXRvcmFpcyBwYXJhIGNvbmNlZGVyIMOgIFNpZ2xhIGRlIFVuaXZlcnNpZGFkZSAKb3MgZGlyZWl0b3MgYXByZXNlbnRhZG9zIG5lc3RhIGxpY2Vuw6dhLCBlIHF1ZSBlc3NlIG1hdGVyaWFsIGRlIHByb3ByaWVkYWRlIGRlIHRlcmNlaXJvcyBlc3TDoSBjbGFyYW1lbnRlIAppZGVudGlmaWNhZG8gZSByZWNvbmhlY2lkbyBubyB0ZXh0byBvdSBubyBjb250ZcO6ZG8gZGEgdGVzZSBvdSBkaXNzZXJ0YcOnw6NvIG9yYSBkZXBvc2l0YWRhLgoKQ0FTTyBBIFRFU0UgT1UgRElTU0VSVEHDh8ODTyBPUkEgREVQT1NJVEFEQSBURU5IQSBTSURPIFJFU1VMVEFETyBERSBVTSBQQVRST0PDjU5JTyBPVSAKQVBPSU8gREUgVU1BIEFHw4pOQ0lBIERFIEZPTUVOVE8gT1UgT1VUUk8gT1JHQU5JU01PIFFVRSBOw4NPIFNFSkEgQSBTSUdMQSBERSAKVU5JVkVSU0lEQURFLCBWT0PDiiBERUNMQVJBIFFVRSBSRVNQRUlUT1UgVE9ET1MgRSBRVUFJU1FVRVIgRElSRUlUT1MgREUgUkVWSVPDg08gQ09NTyAKVEFNQsOJTSBBUyBERU1BSVMgT0JSSUdBw4fDlUVTIEVYSUdJREFTIFBPUiBDT05UUkFUTyBPVSBBQ09SRE8uCgpBIFNpZ2xhIGRlIFVuaXZlcnNpZGFkZSBzZSBjb21wcm9tZXRlIGEgaWRlbnRpZmljYXIgY2xhcmFtZW50ZSBvIHNldSBub21lIChzKSBvdSBvKHMpIG5vbWUocykgZG8ocykgCmRldGVudG9yKGVzKSBkb3MgZGlyZWl0b3MgYXV0b3JhaXMgZGEgdGVzZSBvdSBkaXNzZXJ0YcOnw6NvLCBlIG7Do28gZmFyw6EgcXVhbHF1ZXIgYWx0ZXJhw6fDo28sIGFsw6ltIGRhcXVlbGFzIApjb25jZWRpZGFzIHBvciBlc3RhIGxpY2Vuw6dhLgo=Biblioteca Digital de Teses e Dissertaçõeshttp://bdtd.famerp.br/PUBhttps://bdtd.famerp.br/oai/requestsbdc@famerp.br||joao.junior@famerp.bropendoar:47112019-02-04T13:06:04Biblioteca Digital de Teses e Dissertações da FAMERP - Faculdade de Medicina de São José do Rio Preto (FAMERP)false |
dc.title.por.fl_str_mv |
Lesão renal aguda após cirurgia cardíaca |
title |
Lesão renal aguda após cirurgia cardíaca |
spellingShingle |
Lesão renal aguda após cirurgia cardíaca Machado, Maurício de Nassau Acute Kidney Injury Thoracic Surgery Myocardial Revascularization Morbidity Mortality Lesão renal aguda Cirurgia Torácica Revascularização miocárdica Morbidade Mortalidade CIENCIAS DA SAUDE::8765449414823306929::600 |
title_short |
Lesão renal aguda após cirurgia cardíaca |
title_full |
Lesão renal aguda após cirurgia cardíaca |
title_fullStr |
Lesão renal aguda após cirurgia cardíaca |
title_full_unstemmed |
Lesão renal aguda após cirurgia cardíaca |
title_sort |
Lesão renal aguda após cirurgia cardíaca |
author |
Machado, Maurício de Nassau |
author_facet |
Machado, Maurício de Nassau |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Maia, Lília Nigro |
dc.contributor.referee1.fl_str_mv |
Braile, Domingo Marcolino |
dc.contributor.referee2.fl_str_mv |
Burdmann, Emmanuel de Almeida |
dc.contributor.referee3.fl_str_mv |
Piegas, Leopoldo Soares |
dc.contributor.referee4.fl_str_mv |
Ramos, Rui Fernando |
dc.contributor.authorID.fl_str_mv |
42653266172 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/6764701625517296 |
dc.contributor.author.fl_str_mv |
Machado, Maurício de Nassau |
contributor_str_mv |
Maia, Lília Nigro Braile, Domingo Marcolino Burdmann, Emmanuel de Almeida Piegas, Leopoldo Soares Ramos, Rui Fernando |
dc.subject.eng.fl_str_mv |
Acute Kidney Injury Thoracic Surgery Myocardial Revascularization Morbidity Mortality |
topic |
Acute Kidney Injury Thoracic Surgery Myocardial Revascularization Morbidity Mortality Lesão renal aguda Cirurgia Torácica Revascularização miocárdica Morbidade Mortalidade CIENCIAS DA SAUDE::8765449414823306929::600 |
dc.subject.por.fl_str_mv |
Lesão renal aguda Cirurgia Torácica Revascularização miocárdica Morbidade Mortalidade |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::8765449414823306929::600 |
description |
Introduction: Acute kidney injury is a complex syndrome characterized by rapid (hours or days) reduction in renal excretion that occurs in a wide variety of situations. It has wide variability of epidemiology and is a common complication in critically ill and intensive care patients. Acute kidney injury generate increased hospital costs and is associated with high mortality rates being independent predictor of death. Currently, three diagnostic criteria for acute kidney injury has been highlighted: RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease), AKIN (Acute Kidney Injury Network) and KDIGO (Kidney Disease: Improving Global Outcomes). Objectives: To evaluate the incidence, morbidity and mortality associated with acute kidney injury (and its value as a predictor of 30-day mortality) in patients undergoing on-pump coronary artery bypass grafting (article 1), patients undergoing cardiac valve surgery (article 2), patients with elevated preoperative baseline creatinine (article 3) and, in general, in patients undergoing cardiac surgery (coronary artery bypass grafting or cardiac valve surgery) (article 4). Methods: (Article 1) Patients undergoing on-pump CABG from January 2003 to January 2008 (817 patients) were divided according to the AKIN classification in AKI (+) and AKI (-) patients. Multivariable logistic regression was used to determine independent predictors of 30-day mortality. (Article 2) Patients undergoing cardiac valve surgery from January 2003 to May 2010 (837 patients) were divided according to the presence of infective endocarditis. Cox regression analysis was used to determine independent predictors of 30-day mortality. (Article 3) Patients with elevated baseline serum creatinine underwent cardiac surgery (CABG or CVS) from January 2003 to June 2013 (918 patients) were evaluated to determine whether the development of post-operative acute kidney injury based on KDIGO criteria was an independent predictor of 30-day mortality. (Article 4) Patients undergoing cardiac surgery (CABG or CVS) between January 2003 and June 2013 (2804 patients) were evaluated to determine if acute kidney injury based on KDIGO criteria was an independent predictor of 30-day mortality. Results: (all articles) Patients who developed AKI postoperatively had more clinical complications. The 30-day mortality increased progressively in all stages of acute kidney injury. Based on AKIN and KDIGO criteria, AKI was an independent predictor of 30-day mortality. Conclusions: (all articles) In this population, acute kidney injury after cardiac surgery was an independent predictor of 30-day mortality. |
publishDate |
2014 |
dc.date.issued.fl_str_mv |
2014-05-07 |
dc.date.accessioned.fl_str_mv |
2016-09-15T18:30:05Z |
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info:eu-repo/semantics/doctoralThesis |
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dc.identifier.citation.fl_str_mv |
Machado, Maurício de Nassau. Lesão renal aguda após cirurgia cardíaca. 2014. 65 p. Tese (Programa de Pós-graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto. |
dc.identifier.uri.fl_str_mv |
http://bdtd.famerp.br/handle/tede/291 |
dc.identifier.doi.por.fl_str_mv |
1189 |
identifier_str_mv |
Machado, Maurício de Nassau. Lesão renal aguda após cirurgia cardíaca. 2014. 65 p. Tese (Programa de Pós-graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto. 1189 |
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