Department of Nephrology, Geisinger Medical Center, Danville, Pennsylvania, USA.
Kidney Int. 2012 Mar;81(5):477-85. doi: 10.1038/ki.2011.405. Epub 2011 Dec 7.
Acute kidney injury increases mortality risk among those with established chronic kidney disease. In this study we used a propensity score-matched cohort method to retrospectively evaluate the risks of death and de novo chronic kidney disease after reversible, hospital-associated acute kidney injury among patients with normal pre-hospitalization kidney function. Of 30,207 discharged patients alive at 90 days, 1610 with reversible acute kidney injury that resolved within the 90 days were successfully matched across multiple parameters with 3652 control patients who had not experienced acute kidney injury. Median follow-up was 3.3 and 3.4 years (injured and control groups, respectively). In Cox proportional hazard models, the risk of death associated with reversible acute kidney injury was significant (hazard ratio 1.50); however, adjustment for the development of chronic kidney injury during follow-up attenuated this risk (hazard ratio 1.18). Reversible acute kidney injury was associated with a significant risk of de novo chronic kidney disease (hazard ratio 1.91). Thus, a resolved episode of hospital-associated acute kidney injury has important implications for the longitudinal surveillance of patients without preexisting, clinically evident kidney disease.
急性肾损伤会增加已患有慢性肾脏病患者的死亡风险。在这项研究中，我们使用倾向评分匹配队列方法，回顾性评估了在肾功能正常的住院相关急性肾损伤患者中，可逆性急性肾损伤在 90 天内恢复后死亡和新发慢性肾脏病的风险。在 30207 名出院后 90 天存活的患者中，有 1610 名患有可逆性急性肾损伤，在多个参数上与 3652 名未发生急性肾损伤的对照组患者成功匹配。中位随访时间分别为 3.3 年和 3.4 年（损伤组和对照组）。在 Cox 比例风险模型中，可逆性急性肾损伤与死亡风险显著相关（风险比 1.50）；然而，随访期间慢性肾脏病发展的调整削弱了这种风险（风险比 1.18）。可逆性急性肾损伤与新发慢性肾脏病的风险显著相关（风险比 1.91）。因此，已恢复的医院相关急性肾损伤与无预先存在的、临床明显的肾脏疾病患者的纵向监测有重要关系。
