Hospital-acquired acute kidney injury in Chinese very elderly persons
Hospital-acquired acute kidney injury in Chinese very elderly persons
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DOI：
10.5301/jn.5000182
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发表时间：
2013-05-01
影响因子：
3.4
通讯作者：
Zhang, Xiaoying
中科院分区：
文献类型：
--
作者：
Wen, Jing;Cheng, Qingli;Zhang, Xiaoying
目的：探讨住院高龄（≥80岁）急性肾损伤（AKI）患者的发病情况、发病因素、预后及相关因素。方法：收集解放军总医院2008年6月1日至2009年12月31日收治的80岁以上患者的临床资料。确定 AKI 患者并分析其临床特征记录。结果：高龄患者 AKI 总体发生率为 14.8%。感染是这些患者 AKI 的主要原因。多因素分析显示，AKI最常见的原因是血容量不足、肾毒性药物、心功能不全和呼吸衰竭。抗生素是肾毒性药物中最常见的因素。与新发AKI相比，慢性急性AKI患者年龄较大，多器官功能障碍综合征（MODS）、高脂血症等并发症发生率及AKI复发率较高。 Cox比例风险模型显示MODS、心力衰竭和胃肠道出血变量是90天终点的独立危险因素，MODS、营养不良、胃肠道出血和SCR绝对增加是一年生存的独立危险因素，α-酮酸的使用被证明是一个保护因素（比值比=0.656）。结论：AKI的发生率非常高。 老年住院患者比例较高。感染、血容量不足、肾毒性药物和心血管疾病是常见原因。积极治疗原发病、避免并发症以及使用α-酮酸有利于改善高龄AKI患者的预后。
Objectives: To investigate the incidence, pathogenetic factors, the prognosis and correlation factors of the hospitalized very elderly patients(>= 80) with acute kidney injury (AKI).Methods: The clinical data of the patients older than 80 admitted in PLA General Hospital from June 1, 2008 to December 31, 2009 were collected. The patients with AKI were identified and their records of clinical characteristics were analyzed.Results: The overall incidence of AKI in very elderly patients was 14.8%. Infection was the major cause of AKI in those patients. The multifactorial analysis showed that the most common causes of AKI were hypovolemia, nephrotoxic drugs, cardiac dysfunction and respiratory failure. Antibiotics were the most common factor in nephrotoxic drugs. Comparing with de novo AKI, the patients with Acute-on-Chronic AKI were older, the percent complication of multiple organ dysfunction syndrome (MODS), hyperlipidemia and the rate of recurring AKI was higher. Cox proportional hazard models showed variables of MODS, heart failure and gastrointestinal bleeding were independent risk factors for 90 days end outpoint, and MODS, malnutrition, gastrointestinal bleeding and absolute increase in SCR were independent risk factors for one year survival, the use of alpha-ketoacid was showed to be a protective factor(odd ratio=0.656).Conclusion: The incidence of AKI in the very elderly hospitalized patients was high. Infections, hypovolemia, nephrotoxic drugs and cardiovascular diseases were among the common causes. Active treatment of primary diseases, avoidance of complications and use of alpha-ketoacid were beneficial for improving the prognosis of the very elderly patients with AKI.