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Akute Nierenfunktionsstörung und Nierenersatztherapie bei Patienten nach außerklinischer Reanimation und Kontrastmittelgabe

Acute kidney injury and renal replacement therapy in victims from out-of-hospital cardiac arrest with administration of contrast agent

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Zusammenfassung

Hintergrund

Für Patienten nach außerklinischem Herz-/Kreislaufstillstand (OHCA) wird die frühe Koronarangiographie und Computertomographie (CT) empfohlen. Beide Untersuchungstechniken erfordern jedoch die Applikation von Kontrastmittel (KM), obwohl die Auswirkung auf die Inzidenz akuter Nierenfunktionsstörungen unklar ist. Diese Studie sollte daher die Inzidenz akuter Nierenfunktionsstörungen und die Notwendigkeit einer Dialysetherapie nach nicht-traumatischem OHCA unter besonderer Berücksichtigung der frühen innerklinischen KM-Applikation untersuchen.

Material und Methode

Retrospektiv wurden die Daten aller Patienten nach OHCA erfasst, die zwischen dem 1. Januar 2008 und dem 30. Juni 2015 in unser Krankenhaus eingeliefert wurden. Die Inzidenz akuter Nierenfunktionsstörungen und Nierenersatzverfahren wurden zwischen den Patientengruppen mit und ohne frühe KM-Gabe verglichen.

Ergebnisse

Von 280 Patienten nach OHCA erhielten 133 Patienten (47,5 %) KM (227,0 ± 136,5 ml). 72 h nach KM-Gabe entwickelten 47 von 129 Überlebenden (36,4 %) irgendeine Form der akuten Nierenfunktionsstörung, jedoch war die akute Nierenfunktionsstörung bei Patienten ohne frühe KM-Gabe häufiger als bei Patienten mit früher KM-Gabe (54,5 vs. 28,2 %; p = 0,011). Patienten, die bis zur Krankenhausentlassung überlebten, hatten bei Aufnahme höhere Serumkreatininwerte als bei Krankenhausentlassung (1,17 ± 0,37 vs. 0,92 ± 0,35; p < 0,001).

Schlussfolgerung

Akute Nierenfunktionsstörungen sind bei Patienten nach OHCA ein häufiger Befund und Nierenersatzverfahren sind häufiger erforderlich als bei anderen kardiologischen Krankheitsbildern. Dennoch konnten wir bei Patienten nach OHCA trotz erhöhter Serumkreatininwerte bei Krankenhausaufnahme keinen Zusammenhang zwischen früher KM-Gabe und akuter Nierenfunktionsstörung zeigen.

Abstract

Background

Early coronary angiography and computed tomography are recommended in survivors of out-of-hospital cardiac arrest (OHCA). However, both techniques require iodinated contrast agent although the effects on incident acute kidney injury are unknown. The aim of this study was to explore the incidence of acute kidney injuries (AKI) and need for renal replacement therapy (RRT) in patients after nontraumatic OHCA with special regard to the administration of contrast agent during the early in-hospital diagnostic workup.

Materials and methods

Data from all survivors of OHCA admitted to our hospital between 1 January 2008 and 30 June 2015 were retrospectively collected. Incidence of AKI and RRT between the contrast and no contrast groups were compared.

Results

Of 280 OHCA survivors, 133 (47.5 %) received contrast agent (227.0 ± 136.5 ml). Within 72 h after hospital admission, 47 of 129 survivors (36.4 %) developed AKI of any stage, but AKI was more common in patients without early contrast administration than in patients with early contrast administration (54.5 vs. 28.2 %; p = 0.011). Patients who survived until hospital discharge had higher serum creatinine levels at admission than at hospital discharge (1.17 ± 0.37 vs. 0.92 ± 0.35; p < 0.001).

Conclusion

AKI is common in survivors of OHCA, and RRT following OHCA is needed more frequently than in other cardiac disease. Despite elevated serum creatinine levels at admission, we could not show an association between early contrast administration in survivors of OHCA and AKI incidence.

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Authors and Affiliations

  1. Medizinische Klinik II (Schwerpunkt Kardiologie und Angiologie), Marienhospital Herne, Ruhr – Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    Martin Christ, Katharina Isabel von Auenmüller, Scharbanu Amirie, Michael Brand, Benjamin Michel Sasko & Hans-Joachim Trappe

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  1. Martin Christ
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  2. Katharina Isabel von Auenmüller
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Correspondence to Martin Christ.

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Interessenkonflikt

M. Christ, K.I. von Auenmüller, S. Amirie, M. Brand, B.M. Sasko und H.-J. Trappe geben an, dass kein Interessenskonflikt besteht.

Alle Untersuchungen wurden mit Zustimmung der zuständigen Ethikkommission und im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt (Ethikvoten: 4889-14 und 15-5415 der zuständigen Ethikkommission der Ruhr-Universität Bochum).

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Christ, M., von Auenmüller, K., Amirie, S. et al. Akute Nierenfunktionsstörung und Nierenersatztherapie bei Patienten nach außerklinischer Reanimation und Kontrastmittelgabe. Herzschr Elektrophys 27, 6–14 (2016). https://doi.org/10.1007/s00399-015-0410-6

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