Our paper 20 years later: from acute renal failure to acute kidney injury-the metamorphosis of a syndrome
Our paper 20 years later: from acute renal failure to acute kidney injury-the metamorphosis of a syndrome
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DOI：
10.1007/s00134-015-3989-5
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发表时间：
2015-11-01
影响因子：
38.9
通讯作者：
Laggner, Anton N.
中科院分区：
文献类型：
--
作者：
Druml, Wilfred;Lenz, Kurt;Laggner, Anton N.
20多年前，我们报告了一个老年急性肾损伤（阿基）危重患者的病例系列分析-当时称为急性肾衰竭。当时，阿基被认为是一种“简单”的并发症，但此后发生了根本性的变化，实际上已成为危重患者的中心综合征之一。我们分析了65岁以上的老年患者，阿基定义为血清肌酐高于3 mg/dl，相当于现代KDIGO 3期，其中大多数需要肾脏替代治疗（RRT）。使用非常完整的数据集，诊断区分了基础疾病实体、阿基的主要原因、急性和慢性风险因素（合并症）。对疾病的严重程度、入院时的早期阿基与晚期阿基、RRT的早期与晚期开始、尽管有RRT指征但未接受RRT治疗的阿基、短期和长期预后的各种指标、肾脏结局、因阿基消退而死亡的患者以及死亡原因等特殊方面进行了评价。粗死亡率为61%，这与现代研究一致，不同亚组之间存在总体差异。无论是在老年患者组内还是与年轻患者组相比，年龄本身都不是生存的决定因素。尽管在观察期内平均年龄和疾病严重程度增加，预后改善。共有17%的患者发展为慢性肾脏疾病。与一般人群相比，长期生存率很低。回顾过去二十年，可以看出一种综合征的显著演变，或者更确切地说是变态。阿基已演变为重症监护患者的中枢综合征，这是一种与多个全身性后遗症和肾外器官损伤相关的全身性疾病过程，不仅对患者而且对肾脏的病程和短期和长期预后产生显著影响。此外，在工业化国家，患有多种合并症的“非肾初治”老年患者已成为最常见的ICU患者。
More than 20 years ago we reported an analysis of a case series of elderly critically ill patients with acute kidney injury (AKI)-then termed acute renal failure. At that time, AKI was regarded as a "simple" complication, but has since undergone a fundamental change and actually has become one of the central syndromes in the critically ill patient.We have analyzed elderly patients above 65 years of age with an AKI defined as serum creatinine above 3 mg/dl corresponding to modern KDIGO stage 3, most of them requiring renal replacement therapy (RRT). Using an extremely complete data set the diagnosis differentiated the underlying disease entity, the dominant cause of AKI, acute and chronic risk factors (comorbidities). Special aspects such as severity of disease, early AKI at admission versus late AKI, early versus later start of RRT, AKI not treated by RRT in spite of indication for RRT, various measures of short-term and long-term prognosis, renal outcome, patients dying with resolved AKI, and causes of death were evaluated.Crude mortality was 61 % which corresponds to modern studies with gross variation among the different subgroups. Age per se was not a determinant of survival either within the group of elderly patients or as compared to younger age groups. Despite an increase in mean age and disease severity during the observation period prognosis improved. A total of 17 % of patients developed a chronic kidney disease. Long-term survival as compared to the general population was low.A look back at the last two decades illustrates a remarkable evolution or rather metamorphosis of a syndrome. AKI has evolved as a central syndrome in intensive care patients, a systemic disease process associated with multiple systemic sequels and extra-renal organ injury and exerting a pronounced effect on the course of disease and short- and long-term prognosis not only of the patient but also of the kidney. Moreover, the "non-renal-na < ve" elderly patient with multiple comorbidities has become the most frequent ICU patient in industrialized nations.