Department of Internal Medicine, Botucatu School of Medicine, UNESP, Botucatu, Brazil.
Nephrol Dial Transplant. 2011 Oct;26(10):3202-6. doi: 10.1093/ndt/gfr359. Epub 2011 Jul 15.
Patients who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality and morbidity. The objectives of this study were to compare clinical and laboratory characteristics of AKI patients evaluated and not evaluated by nephrologists in ICU and generate the hypothesis of the relationship between timing of nephrology consultation and outcome.
We explored associations among presence and timing of nephrology consultation with ICU stay and in-ICU mortality in 148 ICU patients with AKI at a Brazilian teaching hospital from July 2008 to May 2010. Multivariable logistic regression was used to adjust confounding and selection bias.
AKI incidence was 30% and 52% of these AKI patients were evaluated by nephrologists. At multivariable analysis, AKI patients evaluated by nephrologists showed higher Acute Tubular Necrosis-Index Specific Score and creatinine level, more dialysis indications, lower urine output and longer ICU stay. The mortality rate was similar to AKI patients who were not evaluated. Nephrology consultation was delayed (≥ 48 h) in 62.3% (median time to consultation, 4.7 days). Lower serum creatinine levels (P = 0.009) and higher urine output (P = 0.002) were associated with delayed consultation. Delayed consultation was associated with increased ICU mortality (65.4 versus 88.2%, P < 0.001).
In AKI, patients evaluated by nephrologists seem to be more seriously ill than those not evaluated and present similar mortality rate. The delayed nephrology consultation can be associated with increased ICU mortality.
在重症监护病房（ICU）发生急性肾损伤（AKI）的患者具有极高的死亡率和发病率。本研究的目的是比较 ICU 中接受和未接受肾脏病医生评估的 AKI 患者的临床和实验室特征，并提出肾脏病医生咨询时机与结局之间的关系假设。
我们在 2008 年 7 月至 2010 年 5 月期间，对巴西一家教学医院的 148 例 ICU 中 AKI 患者进行了研究，探讨了肾脏病医生咨询的存在和时机与 ICU 住院时间和 ICU 死亡率之间的关联。采用多变量逻辑回归来调整混杂因素和选择偏倚。
AKI 的发生率为 30%，其中 52%的 AKI 患者接受了肾脏病医生的评估。多变量分析显示，接受肾脏病医生评估的 AKI 患者的急性肾小管坏死指数特定评分和肌酐水平较高，透析指征更多，尿量较低，ICU 住院时间更长。死亡率与未接受评估的 AKI 患者相似。肾脏病医生的咨询被延迟（≥48 小时）的占 62.3%（咨询的中位时间为 4.7 天）。较低的血清肌酐水平（P = 0.009）和较高的尿量（P = 0.002）与咨询延迟有关。延迟咨询与 ICU 死亡率增加相关（65.4%与 88.2%，P < 0.001）。
在 AKI 中，接受肾脏病医生评估的患者似乎比未接受评估的患者病情更严重，且死亡率相似。延迟的肾脏病医生咨询可能与 ICU 死亡率增加有关。
