Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data.
Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data.
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DOI：
10.1053/j.ajkd.2015.10.019
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Centers for Disease Control and Prevention CKD Surveillance Team
中科院分区：
文献类型：
--
作者：
Heung M;Steffick DE;Zivin K;Gillespie BW;Banerjee T;Hsu CY;Powe NR;Pavkov ME;Williams DE;Saran R;Shahinian VB;Centers for Disease Control and Prevention CKD Surveillance Team
研究表明，急性肾损伤(AKI)与慢性肾脏疾病(CKD)的长期风险之间存在关联，即使在明显的肾脏恢复之后也是如此。肾功能恢复模式是否能预测急性肾损伤后的肾脏风险尚不清楚。回溯性队列。2011年，退伍军人健康管理局的患者住院(>；24小时)，至少有两次住院血清肌酐测量，基线EGFR和gt；60ml/min/1.73m2，没有诊断出CKD或ESRD：17,049人有AKI(16.3%)，87,715人没有。AKI后肌酐恢复到基线的0.3 mg/dl内的模式：2天内(快速)，3-10天(中期)，10天内无恢复(缓慢或未知)。3级或更高的CKD，定义为两名门诊患者相隔至少90天或CKD诊断、透析或移植60ml/min/1.73m2。CKD的风险用修正的Poisson回归建模，死亡时间删失的CKD用Cox比例风险回归建模，两者都按AKI的分期进行分层。大多数患者的AKI发作为1期(91%)，71%的患者在两天内恢复。在一年内，18.2%的患者已发展为慢性肾脏病(AKI：31.8%，非AKI：15.5%，P<；.001)。在阶段1中，调整后的相对风险比为1.43(95%可信区间1.39~1.48)、2.00(95%可信区间1.88~2.12)和2.65(2.51~2.80)，分别为快速、中度和缓慢/未知恢复。在结合蛋白尿的亚组分析和死亡审查时间对慢性肾脏病的敏感性分析中也观察到了类似的模式。随访时间的变化和主要是男性退伍军人队列可能会限制推广。在住院期间发生AKI的患者在住院一年后发生CKD的风险很大，AKI恢复的时间是一个强有力的预测因素，即使是最轻微的AKI也是如此。
Studies suggest an association between acute kidney injury (AKI) and long-term risk of chronic kidney disease (CKD), even following apparent renal recovery. Whether pattern of renal recovery predicts kidney risk following AKI is unknown. Retrospective cohort. Patients in the Veterans Health Administration in 2011 hospitalized (> 24 hours) with at least two inpatient serum creatinine measurements, baseline eGFR > 60 ml/min/1.73m2 and no diagnosis of CKD or ESRD: 17,049 with AKI (16.3%) and 87,715 without. Pattern of recovery to creatinine within 0.3 mg/dl of baseline after AKI: within 2 days (fast), between 3 and 10 days (intermediate), and no recovery by 10 days (slow or unknown). Stage 3 or higher CKD, defined as 2 outpatient eGFRs <60 ml/min/1.73m2 at least 90 days apart or a CKD diagnosis, dialysis, or transplant. Risk of CKD was modeled using modified Poisson regression and time to death-censored CKD modeled using Cox proportional hazards regression, both stratified by stage of AKI. Most patients’ AKI episodes were Stage 1 (91%) and 71% recovered within two days. At one year, 18.2% had developed CKD (AKI: 31.8%, non-AKI: 15.5%, p<.001). In stage 1, the adjusted relative risk ratios (RR) for Stage 3 or higher CKD were 1.43 (95% CI 1.39–1.48), 2.00 (95% CI 1.88–2.12), and 2.65 (2.51–2.80) for fast, intermediate, and slow/unknown recovery. A similar pattern was observed in subgroup analyses incorporating albuminuria and sensitivity analysis of death-censored time to CKD. Variable timing of follow-up and mostly male veteran cohort may limit generalizability. Patients who develop AKI during a hospitalization are at substantial risk for development of CKD by one year following hospitalization and timing of AKI recovery is a strong predictor, even for the mildest forms of AKI.
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DOI：
10.1053/j.ajkd.2012.03.014
发表时间：
2012-09
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Jones J;Holmen J;De Graauw J;Jovanovich A;Thornton S;Chonchol M
通讯作者：
Chonchol M
影响因子：
19.6
作者：
Barrera-Chimal, Jonatan;Perez-Villalva, Rosalba;Bobadilla, Norma A.
通讯作者：
Bobadilla, Norma A.
影响因子：
13.2
作者：
Mammen, Cherry;Al Abbas, Abdullah;Matsell, Douglas G.
通讯作者：
Matsell, Douglas G.
影响因子：
19.6
作者：
Bucaloiu, Ion D.;Kirchner, H. Lester;Perkins, Robert M.
通讯作者：
Perkins, Robert M.
影响因子：
2.8
作者：
Choi, Joon Seok;Kim, Young A.;Kim, Soo Wan
通讯作者：
Kim, Soo Wan