Hsu C Y, Ordoñez J D, Chertow G M, Fan D, McCulloch C E, Go A S
Department of Medicine, University of California, San Francisco, California 94143-0532, USA.
Kidney Int. 2008 Jul;74(1):101-7. doi: 10.1038/ki.2008.107. Epub 2008 Apr 2.
Few studies have defined how the risk of hospital-acquired acute renal failure varies with the level of estimated glomerular filtration rate (GFR). It is also not clear whether common factors such as diabetes mellitus, hypertension and proteinuria increase the risk of nosocomial acute renal failure independent of GFR. To determine this we compared 1,746 hospitalized adult members of Kaiser Permanente Northern California who developed dialysis-requiring acute renal failure with 600,820 hospitalized members who did not. Patient GFR was estimated from the most recent outpatient serum creatinine measurement prior to admission. The adjusted odds ratios were significantly and progressively elevated from 1.95 to 40.07 for stage 3 through stage 5 patients (not yet on maintenance dialysis) compared to patients with estimated GFR in the stage 1 and 2 range. Similar associations were seen after controlling for inpatient risk factors. Pre-admission baseline diabetes mellitus, diagnosed hypertension and known proteinuria were also independent risk factors for acute kidney failure. Our study shows that the propensity to develop in-hospital acute kidney failure is another complication of chronic kidney disease whose risk markedly increases even in the upper half of stage 3 estimated GFR. Several common risk factors for chronic kidney disease also increase the peril of nosocomial acute kidney failure.
很少有研究明确医院获得性急性肾衰竭的风险如何随估计肾小球滤过率（GFR）水平而变化。糖尿病、高血压和蛋白尿等常见因素是否会在不依赖GFR的情况下增加医院获得性急性肾衰竭的风险也尚不清楚。为了确定这一点，我们将北加利福尼亚州凯撒医疗集团1746名因急性肾衰竭需要透析的住院成年患者与600820名未发生急性肾衰竭的住院患者进行了比较。患者的GFR根据入院前最近一次门诊血清肌酐测量值估算。与估算GFR处于1期和2期范围的患者相比，3期至5期患者（尚未接受维持性透析）的校正比值比从1.95显著逐步升高至40.07。在控制住院风险因素后也观察到类似的关联。入院前的基线糖尿病、确诊高血压和已知蛋白尿也是急性肾衰竭的独立危险因素。我们的研究表明，发生院内急性肾衰竭的倾向是慢性肾病的另一种并发症，即使在估算GFR处于3期上半段时，其风险也会显著增加。几种常见的慢性肾病危险因素也会增加医院获得性急性肾衰竭的风险。
