Acute kidney injury in China: a cross-sectional survey
Acute kidney injury in China: a cross-sectional survey
复制标题
中国急性肾损伤：横断面调查
DOI：
10.1016/s0140-6736(15)00344-x
复制
发表时间：
2015-10-10
期刊：
影响因子：
168.9
通讯作者：
Wang, Haiyan
中科院分区：
文献类型：
--
作者：
Yang, Li;Xing, Guolan;Wang, Haiyan
背景急性肾损伤已成为世界性的公共卫生问题，但对中国的疾病负担却知之甚少。目的评估急性肾功能衰竭患者的负担，评估其在中国的可获得性。方法对2013年在内地22个省份的学术或地方医院住院的成年中国患者进行横断面调查。实验室信息系统根据血清肌酐的变化筛选出疑似AKI的患者，并回顾2个月(1月和7月)的医疗记录以确认诊断。我们根据两个鉴定标准评估AKI的发生率：2012年肾脏疾病：改善全球预后(KDIGO)AKI定义和住院期间血清肌酐上升或下降50%(扩大标准)。我们根据中国国家卫生和计划生育委员会和国家统计局2013年报告的数据估算了全国发病率。2013年在44家筛查医院住院的2223 230名患者中，154 950名(7.0%)通过电子筛查怀疑患有AKI，其中26086名患者(374 286名住院总人数)复查了病历以确认AKI的诊断。根据KDIGO标准和扩展标准的AKI的发现率分别为0.99%(3687/374286)和2.03%(7604/374286)，据此我们估计2013年中国住院的AKI140-290万人。AKI的未识别率为74.2%(7555例可用数据中有5608例)。21.4%(1625/7604)的AKI患者接受了肾脏转诊，59.3%(531/896)的AKI患者接受了肾脏替代治疗。急性心肌梗死识别延迟是院内死亡率的独立危险因素，肾脏转诊是急性心肌梗死认识不足和死亡率的独立保护因素。肾病学家应该承担起领导与AKI斗争的责任。
Background Acute kidney injury (AKI) has become a worldwide public health problem, but little information is available about the disease burden in China. We aimed to evaluate the burden of AKI and assess the availability of diagnosis and treatment in China.Methods We launched a nationwide, cross-sectional survey of adult patients who were admitted to hospital in 2013 in academic or local hospitals from 22 provinces in mainland China. Patients with suspected AKI were screened out on the basis of changes in serum creatinine by the Laboratory Information System, and we reviewed medical records for 2 months (January and July) to confirm diagnoses. We assessed rates of AKI according to two identification criteria: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition and an increase or decrease in serum creatinine by 50% during hospital stay (expanded criteria). We estimated national rates with data from the 2013 report by the Chinese National Health and Family Planning Commission and National Bureau of Statistics.Findings Of 2 223 230 patients admitted to the 44 hospitals screened in 2013, 154 950 (7.0%) were suspected of having AKI by electronic screening, of whom 26 086 patients (from 374 286 total admissions) were reviewed with medical records to confirm the diagnosis of AKI. The detection rate of AKI was 0.99% (3687 of 374 286) by KDIGO criteria and 2.03% (7604 of 374 286) by expanded criteria, from which we estimate that 1.4-2.9 million people with AKI were admitted to hospital in China in 2013. The non-recognition rate of AKI was 74.2% (5608 of 7555 with available data). Renal referral was done in 21.4% (1625 of 7604) of the AKI cases, and renal replacement therapy was done in 59.3% (531 of 896) of those who had the indications. Delayed AKI recognition was an independent risk factor for in-hospital mortality, and renal referral was an independent protective factor for AKI under-recognition and mortalityInterpretation AKI has become a huge medical burden in China, with substantial underdiagnosis and undertreatment. Nephrologists should take the responsibility for leading the battle against AKI.