Hospital and Community Acquired Acute Renal Failure

描述（由申请人提供）： 医院获得性急性肾衰竭（ARF）与不可接受的高死亡率相关。根据ARF（需要透析或不需要透析）和基础疾病的严重程度，短期死亡率范围为30-70%或更高，并且几十年来一直保持在这一水平。虽然ARF可能发生在5%或更多的住院患者中，但ARF的异质性和伴随的合并症以及急性疾病的严重程度使其难以研究。ARF的临床试验需要指导和改善实践，但缺乏ARF的适当定义等基本信息。在这项研究中，我们提出了医院获得性ARF的循证定义，并确定ARF，死亡率，并发症，住院时间和费用之间的独立关联。我们将确定潜在疾病过程之间是否存在重要的相互作用，并使用替代ARF定义估计ARF对死亡率、住院时间和费用的影响。我们将利用计算机化病历中的信息确定多种基于证据的ARF定义的预测因子。我们将使用其他ARF定义确定社区获得性ARF的发生率和估计影响。最后，我们将评估在不同定义下预防和治疗ARF的理论药物的成本效益。数据来源包括基于布莱根妇女医院（BWH）住院患者的现有数据集，以及来自计划的12个月前瞻性研究的数据，该研究收集了BWH和UCSF医疗中心住院和门诊患者的管理数据。将纳入对ARF病例和对照随机样本的病历审查，以确定ARF合并症和病因学的替代指标是否充分。本研究将通过提供基本信息（ARF定义、发生率、后果和成本）的基础，有效地为肾脏病学界提供信息，并在此基础上建立临床试验网络。

DESCRIPTION (provided by applicant): Hospital-acquired acute renal failure (ARF) is associated with an unacceptably high mortality rate. Depending on the severity of ARF (dialysis- or non-dialysis-requiring) and underlying disease, short-term mortality rates range from 30-70% or more, and have remained at these levels for several decades. While ARF may develop in 5% or more of hospitalized patients, the heterogeneity of ARF and accompanying comorbidity and severity of acute illness make it difficult to study. Clinical trials in ARF are needed to guide and improve practice, but fundamental information such as the appropriate definition of ARF is lacking. In this study, we propose to derive evidence-based definitions of hospital-acquired ARF and determine the independent associations among ARF, mortality, complications, length of stay and costs. We will determine whether there are important interactions among underlying disease processes and the estimated effects of ARF on mortality, length of stay and costs using alternative ARF definitions. We will determine predictors of multiple evidence-based definitions of ARF using information available in computerized medical records. We will determine the incidence and estimated effects of community-acquired ARF using alternative ARF definitions. Finally, we will evaluate the cost-effectiveness of theoretical agents for the prevention and treatment of ARF under alternative definitions. Data sources include an existing dataset based on hospitalized patients at Brigham and Women's Hospital (BWH), and data from a planned 12-month prospective study collecting administrative data on hospitalized and ambulatory patients at BWH and UCSF Medical Center. Medical record review of a random sample of ARF cases and controls will be incorporated to determine the adequacy of proxies for comorbidity and etiology of ARF. This study will efficiently inform the Nephrology community by providing a foundation of fundamental information (ARF definitions, incidence, consequences and costs) upon which a clinical trials network can be built.