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Evaluation der Prognose des akuten Nierenversagens nach kardiopulmonaler Reanimation und milder therapeutischer Hypothermie

Evaluation of the prognosis of acute kidney injury after cardiopulmonary resuscitation and mild therapeutic hypothermia

Alexander James Barclay-Steuart
Doctoral thesis
Date of Examination: 2016-02-11
Date of issue: 2016-02-03
Advisor: Blaschke, Sabine Prof. Dr.
Referee: Bräuer, Anselm Prof. Dr.
Referee: Unterberg-Buchwald, Christina Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0028-86B3-8

 

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Abstract

English

Every year, about 350 000 people in Europe suffer an out-of-hospital cardiac arrest and must undergo cardiopulmonary resuscitation. The related mortality and neurological outcome could be significantly improved with the introduction of mild therapeutic hypothermia (MTH) as a standard procedure in the post resuscitation phase. Another serious complication after successful resuscitation is of acute kidney injury (AKI). The aim of this retrospective study was to evaluate the incidence of AKI after successful cardiopulmonary resuscitation and the initiation of a mild hypothermia. In comparison, a control study group was used, where patients did not receive this therapeutic treatment. This retrospective analysis was based on the documentation of 346 successfully resuscitated adults. A mild therapeutic hypothermia group (n = 202) and a control group (n = 144) were formed and divided into dichotomous groups. A statistical data analysis was carried out, incorporating the co-factors: gender, diabetes mellitus and the risk factors for the development of a chronic kidney injury (CKI). The incidence of AKI was significantly reduced from 45.8% in the control group to 29.2% in the MTH-group (p = 0.0015) by the introduction of the mild hypothermia therapeutic method. For the disease probability of CKI at the time of discharge, the initiated therapy resulted in an ARR of 15.9% (p <0.0001). During the course of therapy the calculated glomerular filtration rate (GFR) showed increasingly better values in the MTH-group, and was significantly higher at the endpoint in comparison to the control group (p <0.0001). Considering the cofactors, a protective effect of therapeutic hypothermia remained in almost all subgroups. However, this positive effect was not found consistently significant. In summary, this retrospective study could demonstrate a protective effect on renal function after the return of spontaneous circulation and induced mild hypothermia. In particular, the female gender seems to positively influence the protective mechanisms of this therapy. The study results showed a negative influence for diabetes mellitus patients, particularly in relation to the GFR.
Keywords: acute kidney injury; cardiopulmonary resuscitation; mild therapeutic hypothermia
Schlagwörter: akutes Nierenversagen; kardiopulmonale Reanimation; milde therapeutische Hypothermie
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