Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Am J Kidney Dis. 2012 Apr;59(4):558-65. doi: 10.1053/j.ajkd.2011.11.034. Epub 2012 Jan 5.
In the nontransplant setting, acute kidney injury (AKI) may lead to chronic kidney disease (CKD) and end-stage renal disease, but the epidemiology of AKI in transplant recipients has not been characterized. The purpose of this study was to determine the incidence and consequences of AKI in kidney transplant recipients outside the peritransplant period and unrelated to acute rejection.
Retrospective longitudinal cohort study.
SETTING & PARTICIPANTS: 27,232 adult Medicare-insured transplant recipients with transplant survival of 6 months or longer in the US Renal Data System in 1995-2000.
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge diagnostic codes were used to identify AKI during the first 3 posttransplant years.
Transplant loss from any cause, mortality (death with a functioning transplant), and death-censored transplant loss.
Estimated glomerular filtration rate calculated by the MDRD (Modification of Diet in Renal Disease) Study equation 6 months posttransplant.
3,066 (11.3%) patients had 4,181 hospitalizations with AKI, of which 14.8% required dialysis therapy. The incidence of AKI more than doubled during the study, and AKI was more frequent in patients with lower levels of transplant function. AKI was associated independently with increased risk of transplant loss from any cause (HR, 2.74; 95% CI, 2.56-2.92), death with a functioning transplant (HR, 2.36; 95% CI, 2.14-2.60), and death-censored transplant loss (HR, 3.17; 95% CI, 2.91-3.46). However, AKI-associated risks paradoxically were higher in patients with earlier CKD stage.
Because of the limited sensitivity of ICD-9-CM codes for non-dialysis-requiring AKI events, the overall incidence of AKI likely is underestimated in this study.
We conclude that AKI is increasingly common and associated with transplant failure and death. Later CKD stage increases the risk of AKI, but AKI-associated risks of transplant failure were greater in those with higher levels of kidney function (earlier CKD stage).
在非移植环境中，急性肾损伤（AKI）可能导致慢性肾脏病（CKD）和终末期肾病，但移植受者 AKI 的流行病学尚未确定。本研究的目的是确定在移植后期间之外且与急性排斥无关的肾移植受者 AKI 的发生率和后果。
回顾性纵向队列研究。
1995-2000 年，在美国肾脏数据系统中，27232 名成年医疗保险受者进行了 6 个月或更长时间的移植生存。
国际疾病分类，第九修订版，临床修正（ICD-9-CM）医院出院诊断代码用于确定移植后 3 年内的 AKI。
3066（11.3%）名患者有 4181 次 AKI 住院，其中 14.8%需要透析治疗。在此期间，AKI 的发生率增加了一倍多，并且 AKI 在移植功能水平较低的患者中更为常见。AKI 与任何原因导致的移植失败风险增加独立相关（HR，2.74；95%CI，2.56-2.92），与功能移植相关的死亡（HR，2.36；95%CI，2.14-2.60）和死亡相关的移植失败（HR，3.17；95%CI，2.91-3.46）。然而，AKI 相关风险在 CKD 分期较早的患者中更高。
由于 ICD-9-CM 代码对非透析相关 AKI 事件的敏感性有限，因此本研究中 AKI 的总发生率可能被低估。
我们得出结论，AKI 越来越常见，并与移植失败和死亡相关。晚期 CKD 阶段增加了 AKI 的风险，但在肾功能较高的患者中，AKI 与移植失败相关的风险更大（早期 CKD 阶段）。
