A cross-sectional study of chemotherapy-related AKI
A cross-sectional study of chemotherapy-related AKI
复制标题
DOI：
10.1007/s00228-021-03115-y
复制
发表时间：
2021-05-15
影响因子：
2.9
通讯作者：
Yang, Li
中科院分区：
文献类型：
--
作者：
Kang, Xin;Zheng, Xizi;Yang, Li
目的 本研究旨在详细说明化疗相关急性肾损伤 (CR-AKI) 的特征并调查其对患者预后的影响。方法 这是一项多中心横断面研究，研究对象是根据中国全国 AKI 调查从医院获得性成人 AKI 患者中筛选出的 CR-AKI 癌症患者。结果 3468 例医院获得性 AKI 患者中，确诊 CR-AKI 258 例。在患者中，20.1% (52/258) 的年龄>= 70 岁。 258例CR-AKI病例中，61例（23.6%）达到AKI 3期，75例（29.1%）达到AKI 2期。其余122例（47.3%）仍处于AKI 1期。共有413种化疗药物与AKI相关，其中铂类化合物（24.5%，101/413）最常见。院内死亡率为14.7%（38/258），AKI未康复率为48.3%（100/207）。 AKI 3 期（OR 2.930，95% CI 1.156-7.427）和年龄 >= 70 岁（OR 3.138，95% CI 1.309-7.519）是院内死亡的独立危险因素。与 2 期或 3 期 AKI 病例相比，1 期 AKI 患者肾功能未恢复的比例较高（57.1% vs. 41.4% vs. 36.4%，P = 0.032）。与其他两组相比，1 期 AKI 患者未发现更多 AKI 发作（82.8% vs. 60.0% vs. 36.1%，P < 0.001）。结论 CR-AKI 在医院获得性 AKI 中所占比例值得注意，且严重 CR-AKI 会增加院内死亡率。轻度 CR-AKI 更容易被忽视，持续性肾损伤在这种情况下很常见。对于接受化疗的患者，应强调早期识别 CR-AKI 并进行个体化治疗。
Purpose This study aims to detail the characteristics of chemotherapy-related acute kidney injury (CR-AKI) and investigate its effect on patient outcomes. Methods This is a multicenter cross-sectional study of cancer patients with CR-AKI screened from hospital-acquired adult AKI patients based on a nationwide AKI survey in China. Results Of the 3468 patients with hospital-acquired AKI, 258 cases of CR-AKI were identified. Of the patients, 20.1% (52/258) were >= 70 years old. Among the 258 CR-AKI cases, 61 (23.6%) reached AKI stage 3, and 75 (29.1%) reached AKI stage 2. The remaining 122 (47.3%) remained at AKI stage 1. A total of 413 chemotherapeutic agents were related to AKI, of which platinum compounds (24.5%, 101/413) were the most common. In-hospital mortality was 14.7% (38/258), and the rate of AKI non-recovery was 48.3% (100/207). AKI stage 3 (OR 2.930, 95% CI 1.156-7.427) and age >= 70 years (OR 3.138, 95% CI 1.309-7.519) were independent risk factors for in-hospital death. Compared to stage 2 or 3 AKI cases, a higher proportion of patients with stage 1 AKI did not recover their renal function (57.1% vs. 41.4% vs. 36.4%, P = 0.032). More AKI episodes were not recognized in patients with stage 1 AKI compared with the other two groups (82.8% vs. 60.0% vs. 36.1%, P < 0.001). Conclusions CR-AKI accounted for a noteworthy proportion of hospital-acquired AKI, and severe CR-AKI increased in-hospital mortality. Mild CR-AKI was more likely to be overlooked, and sustained kidney injury was common in this situation. Recognizing CR-AKI at an early stage and personalizing treatment should be emphasized in those undergoing chemotherapy.