Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure
Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure
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DOI：
10.1016/j.kint.2018.08.036
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发表时间：
2019-01-01
影响因子：
19.6
通讯作者：
Bellomo, Rinaldo
中科院分区：
文献类型：
--
作者：
See, Emily J.;Jayasinghe, Kushani;Bellomo, Rinaldo
需要对急性肾损伤（阿基）的长期结局进行可靠的估计，以告知临床实践并指导卫生保健资源的分配。这项系统性综述和荟萃分析旨在量化阿基与慢性肾脏病（CKD）、终末期肾脏病（ESKD）和死亡之间的关联。通过EMBASE、MEDLINE和灰色文献来源进行了系统检索，以识别使用阿基标准化定义的住院成人队列研究，包括未暴露的对照药物，并对患者进行了至少1年的随访。采用Newcastle-Ottawa量表评估偏倚风险。进行随机效应荟萃分析以汇总风险估计值;亚组、敏感性和荟萃回归分析用于研究异质性。在4973篇引文中，82项研究（包括2，017，437名参与者）符合纳入条件。偏倚的常见来源包括结局数据报告不完整、生化值缺失和混杂因素调整不充分。阿基患者新发或进展性CKD的风险增加（HR 2.67，95% CI 1.99-3.58; 17.76 vs 7.59例病例/100人-年），ESKD（HR 4.81，95% CI 3.04-7.62; 0.47 vs 0.08例病例/100人-年）和死亡（HR 1.80，95% CI 1.61-2.02; 13.19 vs 7.26例死亡/100人-年）。对于所有结局，证实了阿基分期增加的风险梯度。对于死亡率，风险的大小也受到临床环境、基线肾功能、糖尿病和冠心病的影响。这些发现确立了阿基的不良长期结局，同时强调了损伤严重程度和临床环境在风险估计中的重要性。
Reliable estimates of the long-term outcomes of acute kidney injury (AKI) are needed to inform clinical practice and guide allocation of health care resources. This systematic review and meta-analysis aimed to quantify the association between AKI and chronic kidney disease (CKD), end-stage kidney disease (ESKD), and death. Systematic searches were performed through EMBASE, MEDLINE, and grey literature sources to identify cohort studies in hospitalized adults that used standardized definitions for AKI, included a non-exposed comparator, and followed patients for at least 1 year. Risk of bias was assessed by the Newcastle-Ottawa Scale. Random effects meta-analyses were performed to pool risk estimates; subgroup, sensitivity, and meta-regression analyses were used to investigate heterogeneity. Of 4973 citations, 82 studies (comprising 2,017,437 participants) were eligible for inclusion. Common sources of bias included incomplete reporting of outcome data, missing biochemical values, and inadequate adjustment for confounders. Individuals with AKI were at increased risk of new or progressive CKD (HR 2.67, 95% CI 1.99-3.58; 17.76 versus 7.59 cases per 100 person-years), ESKD (HR 4.81, 95% CI 3.04-7.62; 0.47 versus 0.08 cases per 100 person-years), and death (HR 1.80, 95% CI 1.61-2.02; 13.19 versus 7.26 deaths per 100 person-years). A gradient of risk across increasing AKI stages was demonstrated for all outcomes. For mortality, the magnitude of risk was also modified by clinical setting, baseline kidney function, diabetes, and coronary heart disease. These findings establish the poor long-term outcomes of AKI while highlighting the importance of injury severity and clinical setting in the estimation of risk.