Natural history of acute kidney disease in patients with cirrhosis
Natural history of acute kidney disease in patients with cirrhosis
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DOI：
10.1016/j.jhep.2020.08.037
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发表时间：
2021-02-15
影响因子：
25.7
通讯作者：
Angeli, Paolo
中科院分区：
文献类型：
--
作者：
Tonon, Marta;Rosi, Silvia;Angeli, Paolo
背景和目标：2012年，KDIGO小组提出了急性肾损伤（阿基）、急性肾病（AKD）和慢性肾病（CKD）的新定义。根据国际腹水俱乐部采用的定义，阿基已在肝硬化患者中进行了广泛研究。相反，目前还没有与AKD相关的流行病学和临床结局数据。本研究的目的是评估AKD的患病率和对肝硬化患者的临床病程和生存率的影响。方法：共有272例连续肝硬化患者参加我们的门诊被纳入本研究。在入选时收集临床和实验室数据。结果：在随访期间，80例患者（29.4%）发生AKD。42例（52.5%）从AKD首次发作中恢复，26例维持正常肾功能至随访结束。16名患者发生了AKD的第二次发作。在全球范围内，36例患者（45.0%）死于AKD。最后，11例患者（13.8%）的AKD进展为CKD。发生AKD的患者的5年生存率显著低于未发生AKD的患者（34.8% vs. 88.8%，p < 0.001）。AKD患者肝硬化并发症和住院的5年率也高于无AKD的患者。结论：AKD在肝硬化患者中常见。它可以是可逆的，但它可能会复发并进展为CKD。AKD对肝硬化患者的发病率和死亡率有非常负面的影响。总结：肾损害对肝硬化患者有非常负面的影响。肾损害的特征似乎是动态病程，根据肾功能和损害的持续时间，将其定义为急性肾损伤、急性肾脏疾病和慢性肾脏疾病。急性肾脏疾病的作用目前尚不清楚。我们的研究首次表明，急性肾脏疾病在肝硬化患者中很常见，对生存率有非常负面的影响。(C)2020年欧洲肝脏研究协会。Elsevier B.V.出版，保留所有权利。
Background & Aims: In 2012, the KDIGO group proposed new definitions for acute kidney injury (AKI), acute kidney disease (AKD) and chronic kidney disease (CKD). According to the definition adapted by the International Club of Ascites, AKI has been extensively investigated in patients with cirrhosis. On the contrary, there are currently no data on the epidemiology and clinical outcomes associated with AKD. The aim of the study was to assess the prevalence and the impact of AKD on the clinical course and survival of patients with cirrhosis.Methods: A total of 272 consecutive patients with cirrhosis attending our outpatient clinic were included in the study. Clinical and laboratory data were collected at inclusion. Patients were followed-up until death, liver transplant or the end of follow-up.Results: During follow-up, 80 patients developed AKD (29.4%). Forty-two (52.5%) recovered from the first episode of AKD and 26 maintained a normal renal function up to the end of follow-up. Sixteen patients developed a second episode of AKD. Globally, 36 patients (45.0%) died with AKD. Finally, AKD progressed to CKD in 11 patients (13.8%). The 5-year survival rate was significantly lower in patients who developed AKD than in those who did not (34.8% vs. 88.8%, p < 0.001). The 5-year rates of complications of cirrhosis and of hospitalizations were also higher in patients with AKD than in those without AKD.Conclusions: AKD is frequent in patients with cirrhosis. It can be reversible, but it may recur and progress to CKD. AKD has a very negative impact on morbidity and mortality in patients with cirrhosis.Lay summary: Renal impairment has a very negative impact on patients with cirrhosis. Renal impairment seems to be characterized by a very dynamic course, which is defined according to renal function and length of the impairment as acute kidney injury, acute kidney disease and chronic kidney disease. The role of acute kidney disease is currently unknown. Our study shows for the first time that acute kidney disease is frequent in patients with cirrhosis and has a very negative impact on survival. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.