Department of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
Clin J Am Soc Nephrol. 2013 Aug;8(8):1284-91. doi: 10.2215/CJN.06650712. Epub 2013 Apr 18.
Critically ill patients with AKI necessitating renal replacement therapy (RRT) have high in-hospital mortality, and survivors are at risk for kidney dysfunction at hospital discharge. The objective was to evaluate the association between impaired kidney function at hospital discharge with long-term renal and overall survival.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Degree of kidney dysfunction in relation to long-term effects on renal survival and patient mortality was investigated in a retrospective cohort study of 1220 adults admitted to an intensive care unit who received continuous RRT between 1994 and 2010.
After hospital discharge, median follow-up of survivors (n=475) was 8.5 years (range, 1-17 years); overall mortality rate was 75%. Only 170 (35%) patients were discharged with an estimated GFR (eGFR) >60 ml/min per 1.73 m(2). Multivariate proportional hazards regression analysis demonstrated that age, nonsurgical type of admission, preexisting kidney disease, malignancy, and eGFR of 29-15 ml/min per 1.73 m(2) (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.01 to 2.58) and eGFR <15 ml/min per 1.73 m(2) (HR, 1.93; 95% CI, 1.23 to 3.02) at discharge were independent predictors of increased mortality. Renal survival was significantly associated with degree of kidney dysfunction at discharge. An eGFR of 29-15 ml/min per 1.73 m(2) (HR, 26.26; 95% CI, 5.59 to 123.40) and <15 ml/min per 1.73 m(2) (HR, 172.28; 95% CI, 37.72 to 786.75) were independent risk factors for initiation of long-term RRT.
Most critically ill patients surviving AKI necessitating RRT have impaired kidney function at hospital discharge. An eGFR <30 ml/min per 1.73 m(2) is a strong risk factor for decreased long-term survival and poor renal survival.
急性肾损伤（AKI）需要肾脏替代治疗（RRT）的危重症患者院内死亡率高，出院时存活患者存在肾功能障碍的风险。本研究旨在评估出院时肾功能障碍与长期肾功能和总体生存的关系。
设计、地点、参与者和测量方法：本研究为回顾性队列研究，纳入了 1994 年至 2010 年间在重症监护病房接受连续 RRT 的 1220 名成人患者，分析了与长期肾功能影响相关的肾功能障碍程度对肾脏存活率和患者死亡率的影响。
出院后，存活患者（n=475）的中位随访时间为 8.5 年（1-17 年）；总体死亡率为 75%。仅有 170 名（35%）患者出院时估算肾小球滤过率（eGFR）>60ml/min/1.73m2。多变量比例风险回归分析表明，年龄、非手术入院类型、原有肾脏疾病、恶性肿瘤和出院时 eGFR 为 29-15ml/min/1.73m2（风险比[HR]，1.62；95%置信区间[CI]，1.01 至 2.58）和 eGFR<15ml/min/1.73m2（HR，1.93；95%CI，1.23 至 3.02）是死亡率增加的独立预测因素。肾脏存活率与出院时肾功能障碍程度显著相关。eGFR 为 29-15ml/min/1.73m2（HR，26.26；95%CI，5.59 至 123.40）和<15ml/min/1.73m2（HR，172.28；95%CI，37.72 至 786.75）是开始长期 RRT 的独立危险因素。
大多数存活 AKI 需要 RRT 的危重症患者出院时存在肾功能障碍。eGFR<30ml/min/1.73m2 是降低长期生存率和肾功能不良的强烈危险因素。
