Заместительная почечная терапия у реципиентов сердечного трансплантата

Повреждение почек у реципиентов сердечного трансплантата является одним из наиболее серьезных осложнений, влияющим как на кратковременные, так и отдаленные результаты трансплантации. Необходимость применения заместительной почечной терапии (ЗПТ) определяется не только и не столько степенью нарушения функции почек, сколько потребностью в коррекции баланса жидкости и метаболических нарушений. С этими обстоятельствами связана специфика аппаратной заместительной почечной терапии у реципиентов донорского сердца. В данном обзоре рассмотрены проблемы инициации ЗПТ – ранней в сравнении с отсроченной, антикоагуляции и сосудистого доступа, преимущества и недостатки постоянных и интермиттирующих методик. Особое внимание уделено хронизации почечного повреждения и особенностям пересадки почки у пациентов с трансплантированным сердцем.

1. Sigwalt F, Bouteleux A, Dambricourt F, Asselborn T, Moriceau F, Rimmelé T. Clinical Complications of Continuous Renal Replacement Therapy. Bellomo R, Kellum JA, La Manna G, Ronco C. (eds): 40 Years of Continuous Renal Replacement Therapy. Contrib Nephrol. Basel, Karger, 2018; 194: 109–117. doi: 10.1159/000485608.

2. Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstadt H et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA. 2016; 315: 2190–2199. doi: 10.1001/jama.2016.5828.

3. Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016; 375: 122–133. doi: 10.1056/NEJMoa1603017.

4. Combes A, Brechot N, Amour J, Cozic N, Lebreton G, Guidon C et al. Early high-volume hemofiltration versus standard care for post-cardiac surgery shock. The HEROICS study. Am J Respir Crit Care Med. 2015; 192:1179–1190. doi: 10.1164/rccm.201503-0516OC.

5. Wald R, Adhikari NK, Smith OM, Weir MA, Pope K, Cohen A et al. Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury. Kidney Int. 2015; 88: 897–904. doi: 10.1038/ki.2015.184.

6. Jamale TE, Hase NK, Kulkarni M, Pradeep KJ, Keskar V, Jawale S, Mahajan D. Earlier-start versus usual-start dialysis in patients with community acquired acute kidney injury: a randomized controlled trial. Am J Kidney Dis. 2013; 62: 1116–1121. doi: 10.1053/j.ajkd.2013.06.012.

7. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015; 41: 1411–1423. doi: 10.1007/s00134-015-3934-7.

8. Gaudry S, Ricard JD, Leclaire C, Rafat C, Messika J, Bedet A et al. Acute kidney injury in critical care: experience of a conservative strategy. J Crit Care. 2014; 29:1022–1027. doi: 10.1016/j.jcrc.2014.07.014.

9. Gaudry S, Hajage D, Benichou N, Chaïbi K, Barbar S, Zarbock A et al. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials. Lancet. 2020; 395 (10235):1506–1515. doi: 10.1016/S0140-6736(20)30531-6.

10. Rabindranath KS, Kumar E, Shail R, Vaux E. Use of real- time ultrasound guidance for the placement of hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis. 2011; 158: 964–970. doi: 10.1053/j.ajkd.2011.07.025.

11. Prabhu MV, Juneja D, Gopal PB, Sathyanarayanan M, Subhramanyam S, Gandhe S, Nayak KS. Ultrasound-guided femoral dialysis access placement: a single-center randomized trial. Clin J Am Soc Nephrol. 2010; 5: 235–239. doi: 10.2215/CJN.04920709.

12. Kidney disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl. 2012; 2: 1–138. doi: 10.1038/kisup.2012.1.

13. Vinsonneau C, Allain-Launay E, Blayau C, Darmon M, Ducheyron D, Gaillot T et al. Renal replacement therapy in adult and pediatric intensive care: recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD). Ann Intensive Care. 2015; 5: 58. doi: 10.1186/s13613-015-0093-5.

14. Parienti JJ, Mongardon N, Megarbane B, Mira JP, Kalfon P, Gros A et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015; 373 (13): 1220–1229. doi: 10.1056/NEJMoa1500964.

15. Parienti JJ, Megarbane B, Fischer MO, Lautrette A, Gazui N, Marin N et al. Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med. 2010; 38:1118–1125. doi: 10.1097/CCM.0b013e3181d454b3.

16. Coupez E, Timsit JF, Ruckly S, Schwebel C, Gruson D, Canet E et al. Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction? Crit Care. 2016; 20: 230. doi: 10.1186/s13054-016-1402-6.

17. Chua HR, Schneider AG, Sherry NL, Lotfy N, Chan MJ, Galtieri J et al. Initial and extended use of femoral versus nonfemoral double-lumen vascular catheters and catheter-related infection during continuous renal replacement therapy. Am J Kidney Dis. 2014; 64: 909–917. doi: 10.1053/j.ajkd.2014.04.022.

18. Sungur M, Eryuksel E, Yavas S, Bihorac A, Layon AJ, Caruso L. Exit of catheter lock solutions from double lumen acute haemodialysis catheters – an in vitro study. Nephrol Dial Transplant. 2007; 22: 3533–3537. doi: 10.1093/ndt/gfm452.

19. Correa Barcellos F, Pereira Nunes B, Jorge Valle L, Lopes T, Orlando B, Scherer C et al. Comparative effectiveness of 30% trisodium citrate and heparin lock solution in preventing infection and dysfunction of hemodialysis catheters: a randomized controlled trial (CITRIM trial). Infection. 2017; 45 (2): 139–145. doi: 10.1007/s15010-016-0929-4.

20. Landry DL, Braden GL, Gobeille SL, Haessler SD, Vaidya CK, Sweet SJ. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. Clin J Am Soc Nephrol. 2010; 5: 1799–1804. doi: 10.2215/CJN.01270210.

21. Bagshaw SM, Berthiaume LR, Delaney A, Bellomo R. Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis. Crit Care Med. 2008; 36: 610–617. doi: 10.1097/01.CCM.0B013E3181611F552.

22. Zhang L, Yang J, Eastwood GM, Zhu G, Tanaka A, Bellomo R. Extended daily dialysis versus continuous renal replacement therapy for acute kidney injury: a meta- analysis. Am J Kidney Dis. 2015; 66: 322–330. doi: 10.1053/j.ajkd.2015.02.328.

23. Liang KV, Sileanu FE, Clermont G, Murugan R, Pike F, Palevsky PM, Kellum JA. Modality of RRT and recovery of kidney function after AKI in patients surviving to hospital discharge. Clin J Am Soc Nephrol. 2016; 11: 30–38. doi: 10.2215/CJN.01290215.

24. Schneider AG, Bellomo R, Bagshaw SM, Glassford NJ, Lo S, Jun M et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: A systematic review and meta-analysis. Intensive Care Med. 2013; 39: 987–997. doi: 10.1007/s00134-013-2864-5.

25. Wald R, Shariff SZ, Adhikari NKJ, Bagshaw SM, Burns KEA, Friedrich JO et al. The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: A retrospective cohort study. Crit Care Med. 2014; 42:868–877. doi: 10.1097/CCM.0000000000000042.

26. Nash DM, Przech S, Wald R, O’Reilly D. Systematic review and meta-analysis review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017; 41:138–144. doi: 10.1016/j.jcrc.2017.05.002.

27. Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D et al. Intensity of renal support in critically ill patients with acute kidney injury. VA/ NIH Acute Renal Failure Trial Network. N Engl J Med. 2008; 359: 7–20. doi: 10.1056/NEJMoa0802639.

28. Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S et al. Intensity of continuous renal-replacement therapy in critically ill patients. RENAL Replacement Therapy Study Investigators. N Engl J Med. 2009; 361 (17):1627–1638. doi: 10.1056/NEJMoa0902413.

29. Bagshaw SM, Chakravarthi MR, Ricci Z, Tolwani A, Neri M, De Rosa S et al. ADQI Consensus Group. Precision continuous renal replacement therapy and solute control. Blood Purif. 2016; 42: 238–247. doi: 10.1159/000448507.

30. Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010; 55:316–325. doi: 10.1053/j.ajkd.2009.10.048.

31. Teixeira C, Garzotto F, Piccinni P, Brienza N, Iannuzzi M, Gramaticopolo S et al. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care. 2013; 17: R14. doi: 10.1186/cc12484.

32. Garzotto F, Ostermann M, Martin-Langerwerf D, Sanchez- Sanchez M, Teng J, Robert R et al. The dose response multicentre investigation on fluid assessment (DoRe-MIFA) in critically ill patients. Crit Care. 2016; 20: 196. doi: 10.1186/s13054-016-1355-9.

33. De los Reyes VA, Fuertinger DH, Kappel F, Meyring- Wosten A, Thijssen S, Kotanko P. A physiologically based model of vascular refilling during ultrafiltration in hemodialysis. J Theor Biol. 2016; 390: 146–155. doi: 10.1016/j.jtbi.2015.11.012.

34. Sepsis, kidney and multiple organ dysfunction. Proceedings of the Third International Course on Critical Care Nephrology. June 1–4, 2004. Vicenza, Italy Contrib Nephrol. 2004; 144: 1–394. PMID: 15295813.

35. Bai M, Zhou M, He L, Ma F, Li Y, Yu Y et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs. Intensive Care Med. 2015; 41: 2098–2110. doi: 10.1007/s00134-015-4099-0.

36. Klingele M, Seiler S, Poppleton A, Lepper P, Fliser D, Seidel R. The gap between calculated and actual calcium substitution during citrate anticoagulation in an immobilised patient on renal replacement therapy reflects the extent of bone loss – a case report. BMC Nephrol. 2014; 15: 163. doi: 10.1186/1471-2369-15-163.

37. Khadzhynov D, Schelter C, Lieker I, Mika A, Staeck O, Neumayer H-H et al. Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation. J Crit Care. 2014; 29 (2): 265–271. doi: 10.1016/j.jcrc.2013.10.015.

38. Попцов ВН. Почечная функция у больных, находящихся на вспомогательном кровообращении, и реципиентов сердца. Руководство по экстракорпоральному очищению крови в интенсивной терапии. Под ред. Л.А. Бокерия, М.Б. Ярустовского. Издание 3-е, М.: НЦССХ им. А.Н. Бакулева МЗ РФ, 2016. 804 с.

39. Tjahjono R, Connellan M, Granger E. Predictors of Acute Kidney Injury in Cardiac Transplantation. Transplant Proc. 2016; 48 (1): 167–172. doi: 10.1016/j.transproceed.2015.12.006.

40. García-Gigorro R, Renes-Carreño E, Peiretti MAC, López PA, Vela JLP, Rodríguez JG et al. Incidence, Risk Factors and Outcomes of Early Acute Kidney Injury After Heart Transplantation: An 18-year Experience. Transplantation. 2018; 102 (11): 1901–1908. doi: 10.1097/TP.0000000000002293.

41. Wang T-J, Lin C-H, Wei H-J, Wu M-J. Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study. J Clin Med. 2020; 9 (8): 2455. https://doi.org/10.3390/jcm9082455.

42. Wang L, Wang T, Rushton SN, Parry G, Dark JH, Sheerin NS. The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients – a UK cohort study. Transpl Int. 2020 Jun 16. doi: 10.1111/tri.13675.

43. Guven G, Brankovic M, Constantinescu AA, Brugts JJ, Hesselink DA. Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation. Intensive Care Med. 2018; 44: 588–597. doi: 10.1007/s00134-018-5159-z.

44. Shen B, Xu J, Lv W, Jiang W, Wang Y, Nie Y et al. Efficacy of Early Goal-Directed Renal Replacement Therapy for the Treatment of Acute Kidney Injury After Heart Transplantation: A Single-Center 10-Year Experience. J Cardiothorac Vasc Anesth. 2020; 34 (6): 1534–1541. doi: 10.1053/j.jvca.2019.11.022.

45. Lund LH, Edwards LB, Dipchand AI, Goldfarb S, Kucheryavaya AY, Levvey BJ et al. International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Heart Transplantation Report – 2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant. 2016; 35 (10): 1158–1169. doi: 0.1016/j.healun.2016.08.017.

46. Ivey-Miranda JB, Flores-Umanzor E, Farrero-Torres M, Santiago E, Cepas-Guillen PL, Perez-Villa F. Predictors of renal replacement therapy after heart transplantation and its impact on long-term survival. Clin Transplant. 2018; 32 (10): e13401. doi: 10.1111/ctr.13401.

47. Kolsrud O, Karason K, Holmberg E, Ricksten S-E, Felldin M, Samuelsson O, Dellgren G. Renal function and outcome after heart transplantation. J Thorac Cardiovasc Surg. 2018; 155 (4): 1593–1604. doi: 10.1016/j.jtcvs.2017.11.087.

48. Jokinen JJ, Tikkanen J, Kukkonen S, Hämmäinen P, Lommi J, Sipponen J, Lemström KB. Natural course and risk factors for impaired renal function during the first year after heart transplantation. J Heart Lung Transplant. 2010; 29 (6): 633–640. doi: 10.1016/j.healun.2010.01.004.

49. Gude E, Andreassen AK, Arora S, Gullestad L, Grov I, Hartmann A et al. Acute renal failure early after heart transplantation: risk factors and clinical consequences. Clin Transplant. 2010; 24 (6): E207–E213. doi: 10.1111/j.1399-0012.2010.01225.x.

50. Fortrie G, Manintveld OC, Constantinescu AA, van de Woestijne PC, Betjes MGH. Renal function at 1 year after cardiac transplantation rather than acute kidney injury is highly associated with long-term patient survival and loss of renal function – a retrospective cohort study. Transpl Int. 2017; 30 (8): 788–798. doi: 10.1111/tri.12940.

51. Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty- fourth Adult Heart Transplantation Report – 2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. 2017; 36 (10): 1037–1046. doi: 10.1016/j.healun.2017.07.019.

52. Puttarajappa CM, Bernardo JF, John A Kellum JA. Renal Complications Following Lung Transplantation and Heart Transplantation. Crit Care Clin. 2019; 35 (1): 61–73. doi: 10.1016/j.ccc.2018.08.009.

53. El-Husseini A, Aghil A, Ramirez J, Sawaya B, Rajagopalan N, Baz M et al. Outcome of kidney transplant in primary, repeat, and kidney-after-nonrenal solid-organ transplantation: 15-year analysis of recent UNOS database. Clin Transplant. 2017; 31 (11): e13108. doi: 10.1111/ctr.13108.

54. Cassuto JR, Reese PP, Sonnad S, Bloom RD, Levine MH, Olthoff KM et al. Wait list death and survival benefit of kidney transplantation among nonrenal transplant recipients. Am J Transplant. 2010; 10 (11): 2502–2511. doi: 10.1111/j.1600-6143.2010.03292.x.

55. Grupper Av, Grupper Ay, Daly RC, Pereira NL, Hathcock MA, Kremers WK et al. Kidney transplantation as a therapeutic option for end-stage renal disease developing after heart transplantation. J Heart Lung Transplant. 2017; 36 (3): 297–304. doi: 10.1016/j.healun.2016.08.004.

56. Roest S, Hesselink DA, Klimczak-Tomaniak D, Kardys I, Caliskan K, Brugts JJ et al. Incidence of end-stage renal disease after heart transplantation and effect of its treatment on survival. ESC Heart Fail. 2020; 7 (2): 533–541. doi: 10.1002/ehf2.12585.

57. Vermes E, Grimbert P, Sebbag L, Barrou B, Pouteil- Noble C, Pavie A. Long-term results of combined heart and kidney transplantation: a French multicenter study. J Heart Lung Transplant. 2009; 28 (5): 440–445. doi: 10.1016/j.healun.2009.01.020.

58. Czer LSC, Ruzza A, Vespignani R, Jordan S, De Robertis MA, Mirocha J et al. Survival and allograft rejection rates after combined heart and kidney transplantation in comparison with heart transplantation alone. Transplant Proc. 2011; 43 (10): 3869–3876. doi: 10.1016/j.transproceed.2011.08.095.

59. Hermsen JL, Nath DS, del Rio AM, Eickstaedt JB, Wigfield C, Lindsey JD, Edwards NM. Combined heartkidney transplantation: the University of Wisconsin experience. J Heart Lung Transplant. 2007; 26 (11):1119–1126. doi: 10.1016/j.healun.2007.08.011.

60. Pinderski LJ, Kirklin JK, McGiffin D, Brown R, Naftel DC, Young KR Jr et al. Multi-organ transplantation: is there a protective effect against acute and chronic rejection? J Heart Lung Transplant. 2005; 24 (11): 1828–1833. doi: 10.1016/j.healun.2005.03.015.

61. Rana A, Robles S, Russo MJ, Halazun KJ, Woodland DC, Witkowski P et al. The combined organ effect: protection against rejection? Ann Surg. 2008; 248 (5): 871–879. doi: 10.1097/SLA.0b013e31817fc2b8.

62. Шевченко ОП, Курабекова РМ, Цирульникова ОМ. Биомаркеры иммунной толерантности при трансплантации печени. Вестник трансплантологии и искусственных органов. 2016; 18 (3): 137–144.

63. Ruzza A, Czer LSC, Trento A, Esmailian F. Combined heart and kidney transplantation: what is the appropriate surgical sequence? Interactive CardioVascular and Thoracic Surgery. 2013; 17: 416–418. doi: 10.1093/icvts/ivt172.

64. Chacon MM, Roberts EK. Dilemmas for the Cardiac Anesthesiologist: Managing Conflicting Fluid Management Strategies During Combined Heart-Kidney Transplantation. J Cardiothorac Vasc Anesth. 2018; 32 (1): 50–52. doi: 10.1053/j.jvca.2017.10.044.

65. Awad M, Czera LSC, Esmailian F, Jordan S, De Robertis MA, Mirocha J et al. Combined Heart and Kidney Transplantation: A 23-Year Experience. Transplant Proc. 2017; 49 (2): 348–353. doi: 10.1016/j.transproceed.2016.11.040.

66. Toinet T, Dominique I, Cholley I, Vanalderwerelt V, Goujon A, Paret F et al. Renal outcome after simultaneous heart and kidney transplantation. Clin Transplant. 2019; 33 (7): e13615. doi: 10.1111/ctr.13615.

67. Raichlin E, Kushwaha SS, Daly RC, Kremers WK, Frantz RP, Clavell AL et al. Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy. Transplant Proc. 2011; 43 (5): 1871–1876. doi: 10.1016/j.transproceed.2011.01.190.

68. Karamlou T, Welke KF, McMullan DM, Cohen GA, Gelow J, Tibayan FA et al. Combined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: Analysis of 593 combined heartkidney transplants from the United Network Organ Sharing Database. J Thorac Cardiovasc Surg. 2014; 147 (1):456–461. doi: 10.1016/j.jtcvs.2013.09.017.

69. Ramsingh D, Harvey R, Runyon A, Benggon M. Anesthesia for Heart Transplantation. Anesthesiol Clin. 2017; 35(3): 453–471. doi: 10.1016/j.anclin.2017.05.002.

70. Awad MA, Czer LSC, Emerson D, Jordan S, De Robertis MA, Mirocha J et al. Combined Heart and Kidney Transplantation: Clinical Experience in 100 Consecutive Patients. J Am Heart Assoc. 2019; 8 (4): e010570. doi: 10.1161/JAHA.118.010570.

71. Kilic A, Grimm JC, Whitman GJR, Shah AS, Mandal K, Conte JV, Sciortino CM. The survival benefit of simultaneous heart-kidney transplantation extends beyond dialysis-dependent patients. Ann Thorac Surg. 2015; 99 (4): 1321–1327. doi: 10.1016/j.athoracsur.2014.09.026.

72. Schaffer JM, Chiu P, Singh SK, Oyer PE, Reitz BA, Mallidi HR. Heart and Combined Heart–Kidney Transplantation in Patients With Concomitant Renal Insufficiency and End-Stage Heart Failure. American Journal of Transplantation. 2014; 14: 384–396. doi: 10.1111/ajt.12522.

73. Melvinsdottir I, Foley DP, Hess T, Gunnarsson SI, Kohmoto T, Hermsen J et al. Heart and kidney transplant: should they be combined or subsequent? ESC Heart Fail. 2020; 7 (5): 2734–2743. doi: 10.1002/ehf2.12864.

74. Gallo M, Trivedi JR, Schumer EM, Slaughter MS. Combined Heart-Kidney Transplant Versus Sequential Kidney Transplant in Heart Transplant Recipients. J Card Fail. 2020; 26 (7): 574–579. doi: 10.1016/j.cardfail.2020.03.002.

75. Поз ЯЛ, Строков АГ, Попцов ВН, Копылова ЮВ, Крышин КН. Повреждение почек и заместительная почечная терапия у реципиента сердечного трансплантата. Вестник трансплантологии и искусственных органов. 2017; 19 (1): 52–56.

76. Попцов ВН. Сочетанная трансплантация сердца и почки. Вестник трансплантологии и искусственных органов. 2016; 18 (1): 78–82.