Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Clin J Am Soc Nephrol. 2013 Mar;8(3):347-54. doi: 10.2215/CJN.03530412. Epub 2012 Dec 14.
Incidence of AKI in hospitalized patients with cancer is increasing, but reports are scant. The objective of this study was to determine incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a cancer center.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Cross-sectional analysis of prospectively collected data on 3558 patients admitted to the University of Texas M.D. Anderson Cancer Center over 3 months in 2006.
Using modified RIFLE (Risk, Injury, Failure, Loss, ESRD) criteria, 12% of patients admitted to the hospital had AKI, with severity in the Risk, Injury, and Failure categories of 68%, 21%, and 11%, respectively. AKI occurred in 45% of patients during the first 2 days and in 55% thereafter. Dialysis was required in 4% of patients and nephrology consultation in 10%. In the multivariate model, the odds ratio (OR) for developing AKI was significantly higher for diabetes (OR, 1.89; 95% confidence interval [CI], 1.51-2.36), chemotherapy (OR, 1.61; 95% CI, 1.26-2.05), intravenous contrast (OR, 4.55; 95% CI, 3.51-5.89), hyponatremia (OR, 1.97; 95% CI, 1.57-2.47), and antibiotics (OR, 1.52; 95% CI, 1.15-2.02). In patients with AKI, length of stay (100%), cost (106%), and odds for mortality (4.7-fold) were significantly greater.
The rate of AKI in patients admitted to a comprehensive cancer center was higher than the rate in most noncancer settings; was correlated significantly with diabetes, hyponatremia, intravenous contrast, chemotherapy, and antibiotics; and was associated with poorer clinical outcomes. AKI developed in many patients after admission. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.
癌症住院患者急性肾损伤（AKI）的发病率正在增加，但相关报道较少。本研究的目的是确定在癌症中心住院的患者中 AKI 的发生率、临床相关性和结局。
设计、设置、参与者和测量：对 2006 年 3 个月内在德克萨斯大学 MD 安德森癌症中心住院的 3558 例患者前瞻性收集的数据进行横断面分析。
使用改良的 RIFLE（风险、损伤、衰竭、丢失、终末期肾病）标准，12%的入院患者发生 AKI，风险、损伤和衰竭的严重程度分别为 68%、21%和 11%。AKI 发生在入院后前 2 天的 45%的患者中，此后的 55%患者中发生。4%的患者需要透析，10%的患者需要肾内科会诊。在多变量模型中，发生 AKI 的比值比（OR）糖尿病（OR，1.89；95%置信区间[CI]，1.51-2.36）、化疗（OR，1.61；95%CI，1.26-2.05）、静脉内造影剂（OR，4.55；95%CI，3.51-5.89）、低钠血症（OR，1.97；95%CI，1.57-2.47）和抗生素（OR，1.52；95%CI，1.15-2.02）的患者明显更高。在 AKI 患者中，住院时间（100%）、费用（106%）和死亡率（4.7 倍）的可能性明显更高。
在综合性癌症中心住院的患者中 AKI 的发生率高于大多数非癌症环境中的发生率；与糖尿病、低钠血症、静脉内造影剂、化疗和抗生素显著相关；与较差的临床结局相关。AKI 在许多患者入院后发生。需要进行研究以确定是否可以采取积极措施来限制 AKI 并改善结局。
