Service de Néphrologie, Hôpital Maisonneuve-Rosemont, Montréal, Canada.
Nephrol Dial Transplant. 2010 Jul;25(7):2203-9. doi: 10.1093/ndt/gfq011. Epub 2010 Feb 2.
Whilst chronic kidney disease (CKD) has been identified as a risk factor for the development of acute kidney injury (AKI), little has been published about the incidence and outcomes of those acute injuries on chronic stable kidney disease and even less in a referred cohort of CKD patients followed up by nephrologists.
We followed up 6862 patients registered as CKD in British Columbia, Canada for a median time of 19.4 months after they achieved an estimated glomerular filtration rate (eGFR) value < or =30 mL/min/1.73 m(2). AKI was defined as a decrease in eGFR of > or =25% compared to a moving baseline eGFR within 25 days.
Of the CKD patients, 44.9% had at least one AKI episode. Crude incidence rate for a first AKI event was 34.8 per 100 person-years. Older age [adjusted relative risks (RR) = 0.93 by 10 years, 95% confidence intervals (CI) = 0.90, 0.95] was associated with a lower risk of AKI. Of the patients, 15.3% died before dialysis and 18.1% initiated dialysis. AKI was associated with both a higher risk of death (adjusted RR = 2.32, 95% CI = 2.04, 2.64) and an increased risk of dialysis (adjusted RR = 2.33, 95% CI = 2.07, 2.61).
In a referred CKD population, AKI was a frequent event and associated with higher risks of dialysis and mortality. The incidence of AKI appears to be less with older age in this population. Quantification of AKI incidence and its risk factors in different populations is important for clinicians and planners, so that appropriate identification, prevention and treatment strategies can be tested.
虽然慢性肾脏病（CKD）已被确定为急性肾损伤（AKI）发展的一个危险因素，但关于慢性稳定肾脏病患者中急性损伤的发生率和结局的研究甚少，在接受肾脏病医生随访的 CKD 患者转诊队列中则更少。
我们对加拿大不列颠哥伦比亚省登记为 CKD 的 6862 例患者进行了随访，这些患者在估算肾小球滤过率（eGFR）<或=30 mL/min/1.73 m2 后中位时间为 19.4 个月。AKI 的定义为 eGFR 在 25 天内相对于移动基线 eGFR 下降>或=25%。
在 CKD 患者中，44.9%至少发生过一次 AKI 事件。首次 AKI 事件的粗发生率为每 100 人年 34.8 例。年龄较大（调整后的相对风险[RR]每增加 10 岁为 0.93，95%置信区间[CI]为 0.90，0.95）与 AKI 风险降低相关。在这些患者中，15.3%在开始透析前死亡，18.1%开始透析。AKI 与死亡风险增加（调整 RR = 2.32，95%CI = 2.04，2.64）和透析风险增加（调整 RR = 2.33，95%CI = 2.07，2.61）相关。
在转诊的 CKD 人群中，AKI 是一种常见事件，与透析和死亡率增加相关。在该人群中，AKI 的发生率似乎随着年龄的增长而降低。在不同人群中量化 AKI 的发生率及其危险因素对临床医生和规划者很重要，以便可以测试适当的识别、预防和治疗策略。
