Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Kidney Int. 2010 Oct;78(8):803-9. doi: 10.1038/ki.2010.258. Epub 2010 Aug 4.
To determine whether acute kidney injury results in later long-term decline in kidney function we measured changes in kidney function over a 3-year period in adults undergoing coronary angiography who had serum creatinine measurements as part of their clinical care. Acute kidney injury was categorized by the magnitude of increase in serum creatinine (mild (50-99% or >or=0.3 mg/dl) and moderate or severe (>or=100%)) within 7 days of coronary angiography. Compared to patients without acute kidney injury, the adjusted odds of a sustained decline in kidney function at 3 months following angiography increased more than 4-fold for patients with mild to more than 17-fold for those with moderate or severe acute kidney injury. Among those with an estimated glomerular filtration rate after angiography less than 90 ml/min per 1.73 m(2), the subsequent adjusted mean rate of decline in estimated glomerular filtration rate during long-term follow-up (all normalized to 1.73 m(2) per year) was 0.2 ml/min in patients without acute kidney injury, 0.8 ml/min following mild injury, and 2.8 ml/min following moderate to severe acute kidney injury. Thus, acute kidney injury following coronary angiography is associated with a sustained loss and a larger rate of future decline in kidney function.
为了确定急性肾损伤是否会导致随后的肾功能长期下降，我们在接受冠状动脉造影的成年人中，测量了 3 年内肾功能的变化，这些成年人的临床护理中包括血清肌酐测量。急性肾损伤的分类标准是在冠状动脉造影后 7 天内血清肌酐升高的幅度（轻度（50-99%或>=0.3mg/dl）和中度或重度（>=100%））。与无急性肾损伤的患者相比，轻度至中度或重度急性肾损伤患者在造影后 3 个月时肾功能持续下降的调整后比值比增加了 4 倍以上。在造影后肾小球滤过率估计值低于 90ml/min/1.73m(2)的患者中，随后在长期随访期间估计肾小球滤过率的调整后平均下降率（均按 1.73m(2)归一化）在无急性肾损伤的患者中为 0.2ml/min，轻度损伤后为 0.8ml/min，中度至重度急性肾损伤后为 2.8ml/min。因此，冠状动脉造影后的急性肾损伤与肾功能的持续丧失和未来下降速度加快有关。
