National Study of Community-Acquired Acute Kidney Injury Epidemiology and Outcomes

项目摘要 社区获得性急性肾损伤（CA-AKI）是在医院环境外发生的阿基， 是阿基最常见的形式。迄今为止，关于CA-AKI的大部分研究都局限于 急性住院（即入院时发现患有阿基的患者），这仅代表 整体CA-AKI负担。值得注意的是，这些CA-AKI估计值在很大程度上是在以下研究中评估的： 美国（US）以外的综合卫生系统;美国缺乏此类国家估计数 人口。尽管缺乏证据基础，但估计表明大多数CA-AKI事件并不 导致急性住院治疗，但门诊CA-AKI事件的特征仍然很差。无论设置， CA-AKI预示着长期预后不良的风险显著升高，包括 住院、肾功能不良和死亡。此外，有一个有限的证据，通知少数 指导CA-AKI管理的指南，没有描述提供者在CA-AKI善后中的作用， 结果。通过系统的研究计划，本研究的目标是评估CA的连续性- 通过严格评价1）用于识别CA-AKI的测量方法，2）CA-AKI临床 结果，和3）CA-AKI发展的风险因素和病因。这将通过合并 几年来，国家退伍军人医疗保健管理局的实验室和管理数据， 医疗保险管理数据，以促进CA-AKI发展和后续临床 后果该项目有三个具体目标：本研究的目标1将描述CA的流行病学， 阿基，通过应用各种临床测量方法来定义CA-AKI发展并描述CA-AKI， 退伍军人健康管理局的阿基发生率，目标2将评估不良临床风险， 结果包括与CA-AKI发展相关的住院或死亡。通过这项工作，Aim 3将对已确定CA-AKI的退伍军人中最常见的CA-AKI临床类型进行分类。我们的方法 是创新的，因为它将是第一个研究：（1）使用国家数据集全面审查 美国人群队列中基于门诊的CA-AKI结局，以及（2）识别最常见的CA类型- 阿基，这将为定制的CA-AKI风险分层提供信息。该项目将确定改善护理的领域 CA-AKI的预防和临床管理标准，提供了急需的经验基础， 完善临床指南，并为未来的发展提供信息，有针对性的干预措施旨在改善 CA-AKI的临床管理以及相关发病率和死亡率。

PROJECT SUMMARY Community-acquired acute kidney injury (CA-AKI) is the development of AKI outside of the hospital setting and is the most common form of AKI. Much of the research to date on CA-AKI has been limited to episodes during an acute hospitalization (i.e. patients found to have AKI upon admission), which represents only a fraction of the overall CA-AKI burden. Notably, these CA-AKI estimates are largely assessed in studies conducted in integrated health systems outside of the United States (US); such national estimates are lacking in US populations. Despite this scant evidence base, estimates indicate that a majority of CA-AKI events do not result in acute hospitalization, yet outpatient CA-AKI events remain poorly characterized. Regardless of setting, CA-AKI portends a significantly high risk of poor long-term outcomes, including increased risk of hospitalization, poor renal outcomes and death. Moreover, there is a limited evidence that informs the few guidelines directing CA-AKI management, and none delineate the role of the provider in CA-AKI aftercare or outcomes. Through a systematic program of research, the goal of this study is to assess the continuum of CA- AKI through rigorous evaluation of 1) measurement approaches for identifying CA-AKI, 2) CA-AKI clinical outcomes, and 3) risk factors and etiologies for CA-AKI development. This will be accomplished by merging several years of national Veterans Healthcare Administration's laboratory and administrative data with Medicare administrative data to facilitate a national evaluation of CA-AKI development and subsequent clinical consequences. This project has three specific aims: Aim 1 of this study will describe the epidemiology of CA- AKI, by applying various clinical measurement approaches to define CA-AKI development and describe CA- AKI incidence in the Veterans Health administration, and Aim 2 will assess the risk of adverse clinical outcomes including hospitalization or death associated with CA-AKI development. Building from this work, Aim 3 will classify the most common clinical types of CA-AKI among veterans with identified CA-AKI. Our approach is innovative because it will be the first study to: (1) use national datasets to comprehensively examine outpatient-based CA-AKI outcomes in a US population cohort and (2) identify the most common types of CA- AKI which will inform tailored CA-AKI risk stratification. This project will identify areas for improving care standards for prevention and clinical management of CA-AKI, provide a critically needed empirical basis to refine clinical guidelines, and inform the development of future, targeted interventions designed to improve the clinical management of CA-AKI and related morbidity and mortality.