肾病患者经皮冠状动脉介入治疗后新发需要透析的危险因素

Risk factors for new requirement for dialysis after percutaneous coronary intervention in patients with kidney disease

目的探索肾病患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后新发需要透析(new requirement for dialysis,NRD)的危险因素.方法入选2010年1月至2015年12月间广东省人民医院2 712例行PCI治疗的肾病患者(肌酐清除率<90 mL/min),以患者术后的院内新发NRD为主要终点,利用Logistic回归分析来分析发生新发NRD的危险因素.结果34(1.25%)例患者发生NRD.多因素Logistic回归分析显示,矫正年龄、性别等因素后,糖尿病(OR=3.9,95%CI:1.4~11.1,P<0.05)、严重肾病(OR=3.3,95%CI:1.1~9.9,P<0.05,P<0.05)、低血压(OR=11.5,95%CI:2.0~17,P<0.05)、心力衰竭(OR=4.1,95%CI:1.4~11.5,P<0.05)、急性心肌梗死(OR=3.2,95%CI:1.1~9.4,P<0.05)是NRD的独立预测因子.结论本研究结果表明低血压、心力衰竭、糖尿病、严重肾病、急性心肌梗死是行PCI治疗的肾病患者术后新发NRD的独立预测因子,为早期风险评估及积极预防提供依据.

Objectives To explore the pre-procedural risk factors of new requirement for dialysis(NRD)after percutaneous coronary intervention(PCI)in patients with kidney disease.Methods We enrolled 2 712 patients with kidney disease(creatinine clearance rate<90 mL/min)who underwent coronary artery angiography(CAG)in Guangdong Provincial People's Hospital from January 2010 to December 2015.NRD during admission was defined as the primary endpoint.Risk factors of NRD were analyzed by Logistics regression analysis.Results NRD occurred in 34(1.25%)patients.Multivariable Logistic regression analysis showed that after adjusting for age,gender and other confounders,diabetes(OR=3.9,95%CI:1.4-11.1,P<0.05),severe kidney disease(OR=3.3,95%CI:1.1-9.9,P<0.05),hypotension(OR=11.5,95%CI:2.0-17,P<0.05),heart failure(OR=4.1,95%CI:1.4-11.5,P<0.05)and acute myocardial infarction(OR=3.2,95%CI:1.1-9.4,P<0.05)were independent predictors of NRD.Conclusions Our data showed that diabetes,severe kidney disease,hypotension,heart failure and acute myocardial infarction were independent predictors of NRD after PCI in patients with renal disease,which provids evidence to support early risk stratification and effective prevention.