Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study
Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study
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DOI：
10.1016/s0140-6736(16)30240-9
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发表时间：
2016-05-14
期刊：
影响因子：
168.9
通讯作者：
Remuzzi, Giuseppe
中科院分区：
文献类型：
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作者：
Mehta, Ravindra L.;Burdmann, Emmanuel A.;Remuzzi, Giuseppe
背景 急性肾损伤的流行病学数据很少，特别是在低收入国家 (LIC) 和中低收入国家 (LMIC)。我们的目的是评估急性肾损伤识别、治疗和结果的区域差异。 方法 在这项跨国横断面研究中，来自 72 个国家 289 个中心的 322 名医生收集了在医院和非医院环境中确诊患有急性肾损伤且符合急性肾损伤标准的儿童和成人患者的前瞻性数据。在急性肾损伤开始时获得就诊时的体征和症状、合并症、急性肾损伤的危险因素和护理过程数据，并在 7 天时以及出院或死亡时（以较早者为准）记录透析需要、肾脏恢复和死亡率。我们根据2014年人均国民总收入将国家分为高收入国家（HIC）、中高收入国家（UMIC）以及低收入国家和中低收入国家（LLMIC）。 结果 2014年9月29日至12月7日期间，收集了4018名患者的数据。 2337 名患者 (58%) 出现社区获得性急性肾损伤，其中 LLMIC 1118 名患者中有 889 名 (80%)，UMIC 1594 名患者中有 815 名 (51%)，HIC 1241 名患者中有 663 名 (51%)（对于 HIC 与 UMIC，p = 0.33；所有其他比较 p < 0.0001）。低血压（1615 [40%] 患者）和脱水（1536 [38%] 患者）是急性肾损伤的最常见原因。脱水是 LLMIC 中急性肾损伤的最常见原因（UMIC 中 1153 人中的 526 [46%] vs 1605 中的 518 [32%] vs HIC 中 1260 中的 492 [39%]）和 HIC 中低血压（UMIC 中 1260 中的 564 [45%] vs 1605 中的 611 [38%%] vs HIC 440 [38%] 的 第1153章 低收入和中等收入国家7 天时的死亡率为 3855 人中的 423 人（11%），低收入中等收入国家（1076 人中的 129 人[12%]）的死亡率高于高收入国家（1230 人中的 125 人[10%]）和 UMIC（1549 人中的 169 人[11%]）。急性肾损伤的识别和治疗。研究的局限性包括来自门诊和低收入国家的少数患者，可能低估了这些地区急性肾损伤的真实负担。需要采取其他策略来提高社区医疗机构（尤其是低收入国家）对急性肾损伤的认识。
Background Epidemiological data for acute kidney injury are scarce, especially in low-income countries (LICs) and lower-middle-income countries (LMICs). We aimed to assess regional differences in acute kidney injury recognition, management, and outcomes.Methods In this multinational cross-sectional study, 322 physicians from 289 centres in 72 countries collected prospective data for paediatric and adult patients with confirmed acute kidney injury in hospital and non-hospital settings who met criteria for acute kidney injury. Signs and symptoms at presentation, comorbidities, risk factors for acute kidney injury, and process-of-care data were obtained at the start of acute kidney injury, and need for dialysis, renal recovery, and mortality recorded at 7 days, and at hospital discharge or death, whichever came earlier. We classified countries into high-income countries (HICs), upper-middle-income countries (UMICs), and combined LICs and LMICs (LLMICs) according to their 2014 gross national income per person.Findings Between Sept 29 and Dec 7, 2014, data were collected from 4018 patients. 2337 (58%) patients developed community-acquired acute kidney injury, with 889 (80%) of 1118 patients in LLMICs, 815 (51%) of 1594 in UMICs, and 663 (51%) of 1241 in HICs (for HICs vs UMICs p = 0.33; p < 0.0001 for all other comparisons). Hypotension (1615 [40%] patients) and dehydration (1536 [38%] patients) were the most common causes of acute kidney injury. Dehydration was the most frequent cause of acute kidney injury in LLMICs (526 [46%] of 1153 vs 518 [32%] of 1605 in UMICs vs 492 [39%] of 1260 in HICs) and hypotension in HICs (564 [45%] of 1260 vs 611 [38%%] of 1605 in UMICs vs 440 [38%] of 1153 LLMICs). Mortality at 7 days was 423 (11%) of 3855, and was higher in LLMICs (129 [12%] of 1076) than in HICs (125 [10%] of 1230) and UMICs (169 [11%] of 1549).Interpretation We identified common aetiological factors across all countries, which might be amenable to a standardised approach for early recognition and treatment of acute kidney injury. Study limitations include a small number of patients from outpatient settings and LICs, potentially under-representing the true burden of acute kidney injury in these areas. Additional strategies are needed to raise awareness of acute kidney injury in community healthcare settings, especially in LICs.