Amin Amit P, Salisbury Adam C, McCullough Peter A, Gosch Kensey, Spertus John A, Venkitachalam Lakshmi, Stolker Joshua M, Parikh Chirag R, Masoudi Frederick A, Jones Phillip G, Kosiborod Mikhail
Department of Cardiovascular Medicine, University of Missouri, Kansas City, MO 64111, USA.
Arch Intern Med. 2012 Feb 13;172(3):246-53. doi: 10.1001/archinternmed.2011.1202.
Acute kidney injury (AKI) is common in patients with acute myocardial infarction (AMI) and is associated with permanent renal impairment and death. Although guidelines increasingly emphasize AKI prevention, whether increased awareness has translated into reduced AKI rates is unclear.
Among 33,249 consecutive hospitalizations in 31,532 unselected patients with AMI across 56 US centers from Cerner Corporation's Health Facts database, we examined the temporal trends in AKI incidence from 2000 to 2008. Acute kidney injury was defined as an absolute increase in creatinine level of at least 0.3 mg/dL or a relative increase of at least 50% during hospitalization.
From 2000 to 2008, the mean age of patients increased (from 66.5 to 68.6 years), as did the known AKI risk factors, including chronic kidney disease, cardiogenic shock, diabetes mellitus, heart failure, coronary angiography, and percutaneous coronary intervention. Despite this, AKI incidence declined from 26.6% in 2000 to 19.7% in 2008 (P < .001). After multivariate adjustment, the trend of decreasing AKI rates persisted (4.4% decline per year; P < .001). In addition, in-hospital mortality also declined over time among patients developing AKI, from 19.9% in 2000 to 13.8% in 2008 (P = .003).
In a large national study, AKI incidence in patients hospitalized with AMI declined significantly from 2000 to 2008 despite the aging population and rising prevalence of AKI risk factors. These findings may reflect increased clinician awareness, better risk stratification, or greater use of AKI prevention efforts during this time period.
急性肾损伤（AKI）在急性心肌梗死（AMI）患者中很常见，并且与永久性肾功能损害和死亡相关。尽管指南越来越强调AKI的预防，但意识的提高是否已转化为AKI发生率的降低尚不清楚。
在来自erner公司健康事实数据库的美国56个中心的31,532例未选定的AMI患者的33,249次连续住院治疗中，我们研究了2000年至2008年AKI发生率的时间趋势。急性肾损伤定义为住院期间肌酐水平绝对升高至少0.3mg/dL或相对升高至少50%。
从2000年到2008年，患者的平均年龄增加（从66.5岁增加到68.6岁），已知的AKI危险因素也增加，包括慢性肾病、心源性休克、糖尿病、心力衰竭、冠状动脉造影和经皮冠状动脉介入治疗。尽管如此，AKI发生率从2000年的26.6%下降到2008年的19.7%（P<0.001）。经过多变量调整后，AKI发生率下降的趋势仍然存在（每年下降4.4%；P<0.001）。此外，发生AKI的患者的住院死亡率也随时间下降，从2000年的19.9%降至2008年的13.8%（P=0.003）。
在一项大型全国性研究中，尽管人口老龄化和AKI危险因素的患病率上升，但2000年至2008年期间，AMI住院患者的AKI发生率仍显著下降。这些发现可能反映了在此期间临床医生意识的提高、更好的风险分层或对AKI预防措施的更多使用。
