Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
BMC Nephrol. 2012 Jul 2;13:51. doi: 10.1186/1471-2369-13-51.
Acute worsening of renal function, an independent risk factor for adverse outcomes in acute decompensated heart failure (ADHF), occurs as a consequence of new onset kidney injury (AKI) or acute deterioration of pre-existed chronic kidney disease (CKD) (acute-on-chronic kidney injury, ACKI). However, the possible difference in prognostic implication between AKI and ACKI has not been well established.
We studied all consecutive patients hospitalized with ADHF from 2003 through 2010 in Nanfang Hospital. We classified patients as with or without pre-existed CKD based on the mean estimated glomerular filtration rate (eGFR) over a six-month period before hospitalization. AKI and ACKI were defined by RIFLE criteria according to the increase of the index serum creatinine.
A total of 1,005 patients were enrolled. The incidence of ACKI was higher than that of AKI. The proportion of patients with diuretic resistance was higher among patients with pre-existed CKD than among those without CKD (16.9% vs. 9.9%, P = 0.002). Compared with AKI, ACKI was associated with higher risk for in-hospital mortality, long hospital stay, and failure in renal function recovery. Pre-existed CKD and development of acute worsening of renal function during hospitalization were the independent risk factors for in-hospital death after adjustment by the other risk factors. The RIFLE classification predicted all-cause and cardiac mortality in both AKI and ACKI.
Patients with ACKI were at greatest risk of adverse short-term outcomes in ADHF. Monitoring eGFR and identifying CKD should not be ignored in patients with cardiovascular disease.
肾功能的急性恶化是急性失代偿性心力衰竭（ADHF）不良结局的独立危险因素，其发生是由于新发的肾损伤（AKI）或预先存在的慢性肾脏病（CKD）的急性恶化（急性合并慢性肾损伤，ACKI）。然而，AKI 和 ACKI 在预后意义上的可能差异尚未得到很好的确定。
我们研究了 2003 年至 2010 年期间在南方医院因 ADHF 住院的所有连续患者。我们根据住院前六个月的平均估计肾小球滤过率（eGFR）将患者分为是否存在预先存在的 CKD。根据血清肌酐指数的升高，根据 RIFLE 标准定义 AKI 和 ACKI。
共纳入 1005 例患者。ACKI 的发生率高于 AKI。在预先存在 CKD 的患者中，利尿剂抵抗的患者比例高于无 CKD 的患者（16.9%比 9.9%，P=0.002）。与 AKI 相比，ACKI 与住院期间死亡率更高、住院时间更长和肾功能恢复失败的风险更高相关。在调整其他危险因素后，预先存在的 CKD 和住院期间肾功能急性恶化是住院期间死亡的独立危险因素。RIFLE 分类预测了 AKI 和 ACKI 的全因和心脏死亡率。
在 ADHF 中，ACKI 患者发生不良短期结局的风险最高。在心血管疾病患者中，监测 eGFR 和识别 CKD 不应被忽视。
