Hsu Chi-yuan, Chertow Glenn M, McCulloch Charles E, Fan Dongjie, Ordoñez Juan D, Go Alan S
Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0532, USA.
Clin J Am Soc Nephrol. 2009 May;4(5):891-8. doi: 10.2215/CJN.05571008. Epub 2009 Apr 30.
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) <45 ml/min per 1.73 m(2). Superimposed ARF was defined as having both a peak inpatient serum creatinine greater than the last outpatient serum creatinine by > or =50% and receipt of acute dialysis.
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.
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.
对于患有慢性肾脏病（CKD）并发生急性肾衰竭（ARF；慢性肾衰竭急性加重）的患者，人们对其临床结局，尤其是长期结局了解相对较少。
设计、地点、参与者及测量：我们追踪了加利福尼亚北部一个综合医疗保健系统的39805名成员，这些成员在1996年至2003年期间住院，且住院前估计肾小球滤过率（eGFR）<45 ml/（min·1.73 m²）。急性肾衰竭的定义为住院期间血清肌酐峰值比上次门诊血清肌酐升高≥50%且接受急性透析治疗。
总体而言，发生急性肾衰竭的CKD患者中有26%在本次住院期间死亡。出院后30天内发生终末期肾病（ESRD）的风险很高，且因入院前肾功能不同而有所差异，基线eGFR为30 - 44 ml/（min·1.73 m²）的住院幸存者中这一比例为42%，基线eGFR为15 - 29 ml/（min·1.73 m²）的住院幸存者中这一比例为63%。与未发生急性肾衰竭的CKD患者相比，发生急性肾衰竭的患者死亡或发生ESRD的长期风险高30%。
在一个基于社区的大型CKD患者队列中，发生一次需要透析的急性肾衰竭与肾功能无法恢复的高风险相关。需要透析的急性肾衰竭似乎也是死亡或ESRD长期风险的一个独立危险因素。
