Ponte Belén, Felipe Carmen, Muriel Alfonso, Tenorio Maria Teresa, Liaño Fernando
Nephrology Department, Ramón y Cajal University Hospital, Madrid, Spain.
Nephrol Dial Transplant. 2008 Dec;23(12):3859-66. doi: 10.1093/ndt/gfn398. Epub 2008 Jul 15.
Data on long-term effects of acute kidney injury (AKI) on renal function (RF) are scarce and factors implicated in the functional outcome are not established. Our aim was to investigate these aspects.
At hospital discharge and annually for 10 years, we retrospectively reviewed RF of 187 patients surviving AKI. Glomerular filtration rates estimated with MDRD equation (eGFR) and KDOQI stages were used to evaluate RF. Only 34.8% of patients had pre-existing renal dysfunction (KDOQI-3). Variables determining long-term RF were collected during AKI and at discharge and analysed with a regression model.
At discharge no patient necessitated dialysis, but eGFR was lower than baseline (47.5 +/- 23.3 ml/min/ 1.73 m(2) versus 75.8 +/- 25.4 ml/min/1.73 m(2)); 38.4% of survivors had recovered basal RF: 26% of those with previous normal RF and 61% of those in KDOQI-3, respectively. At 1 year, eGFR increased to 61.9 +/- 24.4 ml/min/1.73 m(2) and remained stable later. During an 8-year median follow-up (P25:2; P75:10), 31% improved RF, 50% remained stable and 19% deteriorated. In total only 46% (n = 82) definitively recovered RF. Finally, at the end of the study period 61.6% presented some degree of renal dysfunction: 40% of those with previous normal RF developed moderate-severe renal dysfunction and 37% KDOQI-3 progressed into more severe renal failure. Only two patients needed dialysis. Regression model identified age, co-morbidities, discharge eGFR and follow-up time as independent predictors of long-term RF.
AKI carries implication for long-term RF even in patients without pre-existing renal dysfunction. Ageing, co-morbidities and RF at discharge are determinants of the long-term functional outcome.
关于急性肾损伤（AKI）对肾功能（RF）长期影响的数据稀缺，且尚未明确影响功能转归的因素。我们的目的是研究这些方面。
在出院时及之后的10年中，我们对187例AKI存活患者的肾功能进行了回顾性研究。采用MDRD方程估算的肾小球滤过率（eGFR）和KDOQI分期来评估肾功能。仅有34.8%的患者存在既往肾功能不全（KDOQI-3）。在急性肾损伤期间及出院时收集决定长期肾功能的变量，并采用回归模型进行分析。
出院时无患者需要透析，但eGFR低于基线水平（47.5±23.3 ml/min/1.73 m² 对比 75.8±25.4 ml/min/1.73 m²）；38.4%的存活者恢复了基础肾功能：既往肾功能正常者中有26%恢复，KDOQI-3患者中有61%恢复。1年时，eGFR升至61.9±24.4 ml/min/1.73 m² 并在之后保持稳定。在8年的中位随访期（P25：2；P75：10）内，31%的患者肾功能改善，50%保持稳定，19%恶化。总体上仅有46%（n = 82）的患者最终恢复了肾功能。最后，在研究期末，61.6%的患者存在一定程度的肾功能不全：既往肾功能正常者中有40%发展为中重度肾功能不全，KDOQI-3患者中有37%进展为更严重的肾衰竭。仅有2例患者需要透析。回归模型确定年龄、合并症、出院时的eGFR和随访时间是长期肾功能的独立预测因素。
即使在无既往肾功能不全的患者中，急性肾损伤也对长期肾功能有影响。年龄、合并症及出院时的肾功能是长期功能转归的决定因素。
