Short- and long-term outcomes after non-severe acute kidney injury
Short- and long-term outcomes after non-severe acute kidney injury
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DOI：
10.1007/s10157-017-1420-y
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发表时间：
2018-02-01
影响因子：
2.3
通讯作者：
Pascual, Julio
中科院分区：
文献类型：
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作者：
Arias-Cabrales, Carlos;Rodriguez, Eva;Pascual, Julio
背景 严重急性肾损伤 (AKI) 与慢性肾脏病 (CKD)、心血管事件和死亡率增加相关。然而，对于患有非严重 AKI 发作的住院人群的预后知之甚少。本研究的目的是确定非严重 AKI 发作对心血管事件、死亡率和 CKD 的短期和长期影响。 方法 对 2000 年 1 月至 2010 年 12 月期间入住我院的 360 例符合 ADQI 指南 AKI 诊断标准且 AKI 发作后肾功能完全恢复的患者进行回顾性队列研究。诊断 AKI 后 4 年进行了随访。协变量包括人口统计学变量、基线肌酐和合并症的诊断。结果 纳入了 360 名 AKI 幸存者。一年随访后，其中 25 人（6.7%）发展为 CKD。 AKI 患者中高血压（OR 1.62；95% CI 1.2-2.6，p < 0.05）和血清肌酐 >2.6 mg/dL（OR 1.7；95% CI 1.2-3.7，p < 0.05）是独立危险因素。 4年随访后，40名患者（18.3%）发展为CKD；年龄 > 66 岁是一个独立的危险因素（OR 1.03，95% CI 1.03-1.06，p < 0.05）。 4 年死亡率为 25.3%，CKD 患者（OR 4.3，95% CI 1.13-4.90，p < 0.05）和 66 岁以上患者（OR 1.12，95% CI 1.02-1.06，p < 0.05）的死亡率显着更高。 CKD 患者的心血管事件发生率也高于非 CKD 患者（62.7% vs. 21.7%，p < 0.05）。结论 即使在非严重 AKI 发作完全康复后，一些患者仍会发展为 CKD，并且心血管事件发生率和长期死亡率也会增加。
Background Severe acute kidney injury (AKI) is associated with chronic kidney disease (CKD), cardiovascular events and increased mortality. However, little is known about the prognosis in hospitalized population suffering from non-severe AKI episodes. The aim of this study is to determine the impact of non-severe AKI episodes in cardiovascular events, mortality and CKD, on short and long term.Methods Retrospective cohort study to 360 patients who met the criteria for diagnosis of AKI according ADQI guidelines with full recovery of renal function after the AKI episode, admitted between January 2000 and December 2010 in our hospital. Follow-up was 4 years after the diagnosis of AKI. Covariates included demographic variables, baseline creatinine and diagnosis of comorbidities.Results 360 AKI survivor patients were included. Twenty five of them (6.7%) had developed CKD after 1-year follow-up. Hypertension (OR 1.62; 95% CI 1.2-2.6, p < 0.05) and serum creatinine >2.6 mg/dL in AKI (OR 1.7; 95% CI 1.2-3.7, p < 0.05) were independent risk factors. After 4-year follow-up, 40 patients (18.3%) had developed CKD; age >66 years was an independent risk factor (OR 1.03, 95% CI 1.03-1.06, p < 0.05). Mortality rate at 4 years was 25.3% and was significantly higher in CKD patients (OR 4.3, 95% CI 1.13-4.90, p < 0.05) and patients >66 years (OR 1.12, 95% CI 1.02-1.06, p < 0.05). The incidence of cardiovascular events also was higher in CKD patients than in non-CKD patients (62.7 vs. 21.7%, p < 0.05).Conclusion Even after fully recovered non-severe AKI episodes, some patients develop CKD and those have an increase in the incidence of cardiovascular events and long-term mortality.