Impact of acute kidney injury exposure period among liver transplantation patients.
Impact of acute kidney injury exposure period among liver transplantation patients.
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DOI：
10.1186/1471-2369-14-43
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发表时间：
2013-02-20
期刊：
影响因子：
2.3
通讯作者：
Durão MS Jr
中科院分区：
文献类型：
--
作者：
Narciso RC;Ferraz LR;Mies S;Monte JC;dos Santos OF;Neto MC;Rodrigues CJ;Batista MC;Durão MS Jr
急性肾损伤是肝移植的常见并发症。在这项单中心回顾性观察研究中，我们研究了急性肾病对肝受体生存的影响。研究人群包括 2002 年 1 月至 2006 年 11 月期间在巴西圣保罗的一个移植中心接受肝移植的患者。急性肾损伤的诊断和分期是根据急性肾损伤网络的建议进行的，包括在住院期间每天扫描血清肌酐水平。移植前需要肾脏替代治疗的患者、手术前发生急性肾损伤的患者或接受第二次肝移植的患者被排除在研究之外。研究期间总共进行了 444 例肝移植，排除了 129 例（29%）。其余 315 名患者构成研究人群。在 207 例手术中，受者为男性（65%）。人口的平均年龄为 51 岁。移植后 48 小时内、移植后第一周和整个住院期间急性肾损伤的累积发生率分别为 32%、81% 和 93%。 31 例手术（10%）在移植后一周内需要进行肾脏替代治疗，另有 17 例手术（5%）在此之后需要进行替代治疗。平均随访期为 2.3 年。即使在调整了显着的潜在混杂因素后，从急性肾损伤诊断到开始替代治疗或达到血清肌酐峰值的时间（HR 1.03；95% CI 1.01，1.05；p=0.002）与较低的总生存期相关。总体而言，在开始替代治疗之前经历持续一周或更长时间的急性肾损伤的患者的死亡风险增加了三倍（HR 3.02；95% CI 2.04，4.46；p<0.001）。肝移植后急性肾损伤非常频繁，对患者的生存有重大影响。延迟此类人群开始肾脏替代治疗可能会使死亡率每天增加 20% 以上。
Acute kidney injury is a common complication of liver transplantation. In this single-centre retrospective observational study, we investigated the impact of acute kidney disease on liver recipient survival. The study population consisted of patients who underwent a liver engraftment between January 2002 and November 2006, at a single transplantation centre in São Paulo, Brazil. Acute kidney injury diagnosis and staging were according to the recommendations of the Acute Kidney Injury Network and consisted of scanning the daily serum creatinine levels throughout the hospital stay. Patients requiring renal replacement therapy prior to transplantation, those who developed acute kidney injury before the procedure or those receiving their second liver graft were excluded from the study. A total of 444 liver transplantations were performed during the study period, and 129 procedures (29%) were excluded. The remaining 315 patients constituted the study population. In 207 procedures, the recipient was male (65%). The mean age of the population was 51 years. Cumulative incidence of acute kidney injury within 48 h, during the first week after transplantation, and throughout the hospital stay was 32, 81 and 93%, respectively. Renal replacement therapy was required within a week after the transplantation in 31 procedures (10%), and another 17 (5%) required replacement therapy after that period. Mean follow-up period was 2.3 years. Time in days from acute kidney injury diagnosis to initiation of replacement therapy or reaching serum creatinine peak was associated with lower overall survival even when adjusted for significant potential confounders (HR 1.03; 95% CI 1.01, 1.05; p=0.002). Overall, patients experiencing acute kidney injury lasting for a week or more before initiation of replacement therapy experienced a threefold increase in risk of death (HR 3.02; 95% CI 2.04, 4.46; p<0.001). Acute kidney injury after liver transplantation is remarkably frequent and has a substantial impact on patient survival. Delaying the initiation of renal replacement therapy in such population may increase mortality by more than 20% per day.
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DOI：
10.1186/cc10252
发表时间：
2011
期刊：
Critical care (London, England)
影响因子：
--
作者：
Chou YH;Huang TM;Wu VC;Wang CY;Shiao CC;Lai CF;Tsai HB;Chao CT;Young GH;Wang WJ;Kao TW;Lin SL;Han YY;Chou A;Lin TH;Yang YW;Chen YM;Tsai PR;Lin YF;Huang JW;Chiang WC;Chou NK;Ko WJ;Wu KD;Tsai TJ;NSARF Study Group
通讯作者：
NSARF Study Group
影响因子：
19.6
作者：
Coca, Steven G.;King, Joseph T., Jr.;Rosenthal, Ronnie A.;Perkal, Melissa F.;Parikh, Chirag R.
通讯作者：
Parikh, Chirag R.
DOI：
10.2215/cjn.00680207
发表时间：
2007-07-01
影响因子：
9.8
作者：
Andrade, Lucia;Cleto, Sergio;Seguro, Antonio C.
通讯作者：
Seguro, Antonio C.
影响因子：
38.9
作者：
de Mendonça, A;Vincent, JL;Cantraine, F
通讯作者：
Cantraine, F
影响因子：
3.7
作者：
Bagshaw, Sean M.;Uchino, Shigehiko;Kellum, John A.
通讯作者：
Kellum, John A.