Acute Kidney Injury Increases Risk of ESRD among Elderly
Acute Kidney Injury Increases Risk of ESRD among Elderly
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DOI：
10.1681/asn.2007080837
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发表时间：
2009-01-01
影响因子：
13.6
通讯作者：
Collins, Allan J.
中科院分区：
文献类型：
--
作者：
Ishani, Areef;Xue, Jay L.;Collins, Allan J.
尚未在大型代表性样本中研究急性肾损伤（阿基）老年患者的ESRD风险。本研究旨在确定患有阿基的老年人（伴或不伴慢性肾脏疾病（CKD））发生ESRD的发病率和风险比。在2000年的5%随机抽样的医疗保险受益人，临床条件确定使用医疗保险索赔，终末期肾病治疗信息获得的终末期肾病登记在2年的随访。我们的233，803例患者队列于2000年住院，出院时年龄≥ 67岁，既往无ESRD或阿基，出院前享受Medicare资格≥ 2年。在该队列中，3.1%的患者存活至出院，诊断为阿基，5.3/1000人发展为ESRD。在接受ESRD治疗的患者中，25.2%有阿基既往史。校正年龄、性别、种族、糖尿病和高血压后，发生ESRD的风险比为41.2（95%置信区间[CI] 34.6 - 49.1），阿基和CKD患者相对于无肾脏疾病患者，13.0（95% CI 10.6 - 16.0），CKD患者无阿基，8.4（95% CI 7.4 - 9.6）。总之，患有阿基的老年人，特别是那些先前诊断为CKD的人，患ESRD的风险显著增加，表明阿基发作可能加速肾脏疾病的进展。
Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged >= 67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for >= 2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% Cl 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% Cl 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease.