Community-Acquired Acute Kidney Injury: A Nationwide Survey in China
Community-Acquired Acute Kidney Injury: A Nationwide Survey in China
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DOI：
10.1053/j.ajkd.2016.10.034
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发表时间：
2017-05-01
影响因子：
13.2
通讯作者：
Yang, Li
中科院分区：
文献类型：
--
作者：
Wang, Yafang;Wang, Jinwei;Yang, Li
背景：本研究旨在基于全国范围内 AKI 调查来描述中国社区获得性急性肾损伤 (AKI) 的负担。研究设计：横断面和回顾性研究。背景和参与者：使用了来自中国大陆 44 家学术/地方医院的 2,223,230 名住院成年患者的全国样本。 AKI的定义是根据2012年KDIGO AKI肌酐标准或住院期间血清肌酐水平升高或降低50%。当患者患有可在入院时确定的 AKI 时，即可识别出社区获得性 AKI。预测因素：社区获得性 AKI 的发生率、病因、识别和治疗根据患者收治地区的医院类型、纬度和经济发展水平进行分层。结果：全因院内死亡率和出院时肾功能恢复。结果：在 2 个单月快照（2013 年 1 月和 2013 年 7 月）期间，确定了 4,136 名社区获得性 AKI 患者。其中，2,020 例（48.8%）的病例与肾脏灌注减少有关； 1,111 (26.9%)，患有内在肾脏疾病； 499 (12.1%) 为尿路梗阻。与南方相比，北方接触肾毒素或出现尿路梗阻的患者更多。 536 名（13.0%）社区获得性 AKI 患者有肾脏替代治疗（RRT）指征，但其中只有 347 名（64.7%）接受了 RRT。人均国内生产总值较高的地区，及时诊断和适当使用 RRT 的比率较高。全因住院死亡率为 7.3%（4,068 例中有 295 例）。 AKI 识别延迟和位于中国北方是院内死亡的独立危险因素，转诊至肾病科是独立的保护因素。 局限性：由于定义不标准和血清肌酐数据缺失，可能对 AKI 和社区获得性 AKI 进行错误分类。结论：社区获得性 AKI 的特征在中国不同地区差异较大，且与环境、经济和医疗资源密切相关。 (C) 2016 年，国家肾脏基金会，Inc.
Background: This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI.Study Design: Cross-sectional and retrospective study.Setting & Participants: A national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission. Predictors: The rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted. Outcomes: All-cause in-hospital mortality and recovery of kidney function at hospital discharge.Results: 4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor.Limitations: Possible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine.Conclusions: The features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources. (C) 2016 by the National Kidney Foundation, Inc.