The risk of acute renal failure in patients with chronic kidney disease
The risk of acute renal failure in patients with chronic kidney disease
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DOI：
10.1038/ki.2008.107
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发表时间：
2008-07-01
影响因子：
19.6
通讯作者：
Go, A. S.
中科院分区：
文献类型：
--
作者：
Hsu, C. Y.;Ordonez, J. D.;Go, A. S.
很少有研究确定医院获得性急性肾功能衰竭的风险如何随估计的肾小球滤过率（GFR）水平而变化。目前还不清楚常见因素如糖尿病、高血压和蛋白尿是否会增加医院内急性肾功能衰竭的风险，而与GFR无关。为了确定这一点，我们比较了北方加州Kaiser Permanente的1,746名住院成人成员，他们发生了需要透析的急性肾功能衰竭，600,820名住院成员没有。根据入院前最近的门诊血清肌酐测量值估计患者GFR。与GFR估计值在1期和2期范围内的患者相比，3期至5期患者（尚未接受维持透析）的校正比值比从1.95显著逐步升高至40.07。在控制住院风险因素后，也观察到类似的相关性。入院前基线糖尿病、确诊的高血压和已知的蛋白尿也是急性肾衰竭的独立危险因素。我们的研究表明，发生院内急性肾衰竭的倾向是慢性肾脏疾病的另一种并发症，即使在3期估计GFR的上半部分，其风险也显著增加。慢性肾脏疾病的几个常见危险因素也增加了院内急性肾衰竭的危险。
Few studies have defined how the risk of hospital-acquired acute renal failure varies with the level of estimated glomerular filtration rate (GFR). It is also not clear whether common factors such as diabetes mellitus, hypertension and proteinuria increase the risk of nosocomial acute renal failure independent of GFR. To determine this we compared 1,746 hospitalized adult members of Kaiser Permanente Northern California who developed dialysis-requiring acute renal failure with 600,820 hospitalized members who did not. Patient GFR was estimated from the most recent outpatient serum creatinine measurement prior to admission. The adjusted odds ratios were significantly and progressively elevated from 1.95 to 40.07 for stage 3 through stage 5 patients (not yet on maintenance dialysis) compared to patients with estimated GFR in the stage 1 and 2 range. Similar associations were seen after controlling for inpatient risk factors. Pre-admission baseline diabetes mellitus, diagnosed hypertension and known proteinuria were also independent risk factors for acute kidney failure. Our study shows that the propensity to develop in-hospital acute kidney failure is another complication of chronic kidney disease whose risk markedly increases even in the upper half of stage 3 estimated GFR. Several common risk factors for chronic kidney disease also increase the peril of nosocomial acute kidney failure.