Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure
Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure
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DOI：
10.2215/cjn.05571008
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发表时间：
2009-05-01
影响因子：
9.8
通讯作者：
Go, Alan S.
中科院分区：
文献类型：
--
作者：
Hsu, Chi-Yuan;Chertow, Glenn M.;Go, Alan S.
背景和目的：对于慢性肾脏疾病（CKD）合并急性肾功能衰竭（ARF）患者的临床结局，尤其是长期结局，我们所知相对较少。设计、设置、参与者和测量：我们追踪了北加州一个综合医疗保健服务系统的39,805名成员，他们在1996年至2003年期间住院，住院前估计GFR (eGFR) = 50%，并接受急性透析。结果：总体而言，26%合并ARF的CKD患者在指数住院期间死亡。出院后30天内发生ESRD的风险很高，随入院前肾功能的不同而不同，基线eGFR为30-44 ml/min / 1.73 m的住院幸存者中为42%(2)，基线eGFR为15-29 ml/min / 1.73 m的住院幸存者中为63%(2)。与CKD患者相比，没有叠加ARF的患者死亡或ESRD的长期风险高出30%。结论：在一个以社区为基础的大型CKD患者队列中，合并需要透析的ARF发作与肾功能不恢复的非常高的风险相关。需要透析的ARF似乎也是死亡或终末期肾病长期风险的独立危险因素。中华临床医学杂志，2009,31(4):891-898。doi: 10.2215 / CJN.05571008
Background and objectives: Relatively little is known about clinical outcomes, especially long-term outcomes, among patients who have chronic kidney disease (CKD) and experience superimposed acute renal failure (ARF; acute on chronic renal failure).Design, setting, participants, & measurements: We tracked 39,805 members of an integrated health care delivery system in northern California who were hospitalized during 1996 through 2003 and had prehospitalization estimated GFR (eGFR) = 50% and receipt of acute dialysis.Results: Overall, 26% of CKD patients who suffered superimposed ARF died during the index hospitalization. There was a high risk for developing ESRD within 30 d of hospital discharge that varied with preadmission renal function, being 42% among hospital survivors with baseline eGFR 30-44 ml/min per 1.73 m(2) and 63% among hospital survivors with baseline eGFR 15-29 ml/min per 1.73 m(2). Compared with patients who had CKD and did not experience superimposed ARF, those who did had a 30% higher long-term risk for death or ESRD.Conclusions: In a large, community-based cohort of patients with CKD, an episode of superimposed dialysis-requiring ARF was associated with very high risk for nonrecovery of renal function. Dialysis-requiring ARF also seemed to be an independent risk factor for long-term risk for death or ESRD. Clin J Am Soc Nephrol 4: 891-898, 2009. doi: 10.2215/CJN.05571008