Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Moniz, Lisboa, Portugal.
Nephrol Dial Transplant. 2011 Dec;26(12):3888-94. doi: 10.1093/ndt/gfr192. Epub 2011 May 4.
Acute kidney injury (AKI) in hospitalized human immunodeficiency virus (HIV)-infected patients in the highly active antiretroviral therapy (HAART) era has not been extensively addressed. The aim of the present study was to analyze the incidence, etiology, risk factors and the impact of AKI on in-hospital mortality in this population.
A total of 489 HIV-infected patients hospitalized in the Department of Infectious Diseases of the Hospital de Santa Maria (Lisbon, Portugal) between January 2005 and December 2007 were retrospectively studied. AKI was defined by 'Risk Injury Failure Loss of kidney function End-stage kidney disease'(RIFLE) criteria based on serum creatinine. Comparisons between patients with and without AKI were performed using the Student's t-test or the χ2 test. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailed P-value <0.05 was considered significant.
Eighty-eight patients (18%) had AKI within the hospitalization period. The most common etiologies of AKI were sepsis (59%), nephrotoxic drug administration (37.5%), volume depletion (21.6%) and radiocontrast use (20.5%). Preexisting hypertension [adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.04-5.6, P = 0.04], acquired immunodeficiency syndrome (adjusted OR 2.7, 95% CI 1.2-6, P = 0.02), sepsis (adjusted OR 23, 95% CI 11-45.3, P < 0.001) and nephrotoxic drug administration (adjusted OR 2.8, 95% CI 1.4-5.8, P = 0.004) were risk factors of AKI. Patients with AKI had higher in-hospital mortality than patients without AKI (27.3 versus 8%, P < 0.001). In multivariate analysis, AKI was a risk factor of in-hospital mortality (adjusted OR 2.7, 95% CI 1.3-5.6, P = 0.008).
AKI occurred in 18% of hospitalized HIV-infected patients and it was independently associated with increased in-hospital mortality.
在高效抗逆转录病毒治疗（HAART）时代，住院的人类免疫缺陷病毒（HIV）感染患者的急性肾损伤（AKI）尚未得到广泛研究。本研究的目的是分析该人群中 AKI 的发生率、病因、危险因素以及对住院死亡率的影响。
回顾性分析 2005 年 1 月至 2007 年 12 月期间在葡萄牙里斯本圣玛丽亚医院传染病科住院的 489 名 HIV 感染患者。AKI 根据血清肌酐采用“风险损伤衰竭丧失肾脏功能终末期肾病（RIFLE）”标准定义。使用 Student's t 检验或 χ2 检验比较 AKI 患者和无 AKI 患者。使用逻辑回归方法确定 AKI 和住院死亡率的预测因素。双侧 P 值<0.05 被认为具有统计学意义。
88 例（18%）患者在住院期间发生 AKI。AKI 的最常见病因是败血症（59%）、肾毒性药物使用（37.5%）、血容量减少（21.6%）和放射性对比剂使用（20.5%）。高血压病史（调整优势比[OR] 2.4，95%置信区间[CI] 1.04-5.6，P = 0.04）、获得性免疫缺陷综合征（调整 OR 2.7，95%CI 1.2-6，P = 0.02）、败血症（调整 OR 23，95%CI 11-45.3，P < 0.001）和肾毒性药物使用（调整 OR 2.8，95%CI 1.4-5.8，P = 0.004）是 AKI 的危险因素。发生 AKI 的患者的住院死亡率高于未发生 AKI 的患者（27.3%比 8%，P < 0.001）。在多变量分析中，AKI 是住院死亡率的危险因素（调整 OR 2.7，95%CI 1.3-5.6，P = 0.008）。
住院的 HIV 感染患者中有 18%发生 AKI，与住院死亡率升高独立相关。
