JACC:慢性肾病与经导管主动脉瓣置换住院结局的关系

2017-10-17 xiangting MedSci原创

CKD或ESRD患者TAVR后的住院结局差。

这项研究旨在确定慢性肾病(CKD)与经导管主动脉瓣置换术(TAVR)住院结局的关系。

CKD是手术主动脉瓣置换术后(SAVR)的一个已知独立危险因素。然而关于TAVR治疗CKD患者的结果数据很有限,特别是慢性透析患者。

研究人员使用2012年至2014年国家住院病例样本数据库中的数据,以确定所有接受TAVR的≥18岁患者。国际疾病分类-第九版-临床代码用于识别时无CKD、CKD(无慢性透析)或终末期肾病(ESRD)长期透析的患者。使用广义估计方程构建多变量logistic回归模型,以分析住院结局。

在2012年至2014年接受TAVR治疗的41,025例患者中,25,585例(62.4%)无CKD,13505例(33.5%)患CKD,1,690例(4.1%)患有ESRD。与无CKD患者相比,CKD或ESRD患者的住院死亡率明显升高(3.8%vs 4.5%vs 8.3%; CKD调整后的优势比[无CKD作为参考]:1.39 [95%置信区间:1.24-1.55];ESRD为2.58 [95%置信区间:2.09-3.13])。与无CKD患者比较,CKD或ESRD患者重大心血管不良事件(死亡、心肌梗塞或中风的复合),净心血管不良事件(重大心血管不良事件、大出血或血管并发症的复合)和起搏器植入的发生率更高。在无CKD组和CKD组,急性肾损伤(AKI)和需要透析的AKI与风险调整后住院死亡率风险升高数倍相关。此外,在研究期间AKI和需要透析的AKI的发生率没有下降。

CKD或ESRD患者TAVR后的住院结局差。AKI与TAVR患者院内死亡率升高相关,AKI的发病率在过去几年没有下降。

原始出处:
Tanush Gupta, et al. Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions. October 2017. 

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    2017-12-30 hbwxf
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    2018-09-11 yxch48
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    2017-10-19 lsj631
  7. [GetPortalCommentsPageByObjectIdResponse(id=1853809, encodeId=9241185380901, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Dec 30 15:09:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742431, encodeId=d02f1e4243116, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Tue Sep 11 23:09:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325562, encodeId=f5a7132556215, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Thu Oct 19 07:09:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332456, encodeId=5f5513324567e, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Thu Oct 19 07:09:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415205, encodeId=72d7141520548, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Oct 19 07:09:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510090, encodeId=8c4c151009004, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Thu Oct 19 07:09:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1536509, encodeId=80cd153650936, content=<a href='/topic/show?id=a894e826546' target=_blank style='color:#2F92EE;'>#经导管主动脉瓣置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78265, encryptionId=a894e826546, topicName=经导管主动脉瓣置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b38112697961, createdName=yytms, createdTime=Thu Oct 19 07:09:00 CST 2017, time=2017-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253782, encodeId=f1ec253e8277, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Oct 17 19:32:29 CST 2017, time=2017-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=253758, encodeId=10aa253e5898, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Tue Oct 17 18:14:53 CST 2017, time=2017-10-17, status=1, ipAttribution=)]
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    2017-10-17 惠映实验室

    学习了.谢谢.

    0

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    2017-10-17 三生有幸9135

    学习一下谢谢分享

    0

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2017 NICE诊断指南:多频生物电阻抗装置指导慢性肾病患者进行血液透析时的液体管理(DG.29)

2017年6月,英国国家卫生与临床优化研究所 (NICE)发布了多频生物电阻抗装置指导慢性肾病患者进行血液透析时的液体管理的诊断指南,文章评估了应用多频生物电阻抗装置指导慢性肾病患者进行血液透析时的液体管理的临床评价和效益。

JAMA Intern Med:强化降压可降低慢性肾病患者死亡风险

强化动脉压控制可显著降低高血压并慢性肾病患者的全因死亡风险

Circulation:慢性肾病与心脏疾病密切相关,增加了心血管疾病患者的不良预后风险!

慢性肾病(CKD)被认为是全球公共卫生问题。最新的国际临床指南强调肾小球滤过率(GFR)和蛋白尿。CKD与心脏疾病密切相关,增加心血管疾病(CVD)患者的不良预后风险。事实上,大量的研究已经研究了CKD预后与心血管病患者的关系,但大多数研究都集中在肾功能上,对蛋白尿研究的数据有限。

2016共识声明:患有糖尿病和慢性肾病患者应用抗糖尿病药物的剂量调整

糖尿病患者肾功能衰退对于临床医生来讲具有挑战性,包括并发症的管理例如,高血压高脂血症,心血管疾病,贫血等。本文主要针对糖尿病和慢性肾病患者应用抗糖尿病药物的剂量调整提出指导建议。

Nephrology :慢性肾病:甲状旁腺激素治疗的目标及对甲状旁腺功能亢进症的管理

矿物质骨疾病常见于慢性肾病中,主要受继发性甲状旁腺功能亢进症(HPT)驱动。其诊断和治疗是复杂的,但对甲状旁腺激素(PTH)的测量和制定目标是几十年来治疗的重点。2017年5月,发表在《Nephrology (Carlton)》的一项由澳大利亚科学家进行的研究,考察了慢性肾病(CKD)患者进行甲状旁腺激素(PTH)治疗的目标及对HPT的管理。