需要透析的急性肾损伤存活重症监护患者的终末期肾病五年风险：一项全国性队列研究
Five-year risk of end-stage renal disease among intensive care patients surviving dialysis-requiring acute kidney injury: a nationwide cohort study.
作者信息
Gammelager Henrik, Christiansen Christian Fynbo, Johansen Martin Berg, Tønnesen Else, Jespersen Bente, Sørensen Henrik Toft
出版信息
Crit Care. 2013 Jul 22;17(4):R145. doi: 10.1186/cc12824.
INTRODUCTION
Dialysis-requiring acute kidney injury (D-AKI) is common among intensive care unit (ICU) patients. However, follow-up data on the risk of end-stage renal disease (ESRD) among these patients remain sparse. We assessed the short-term and long-term risk of ESRD after D-AKI, compared it with the risk in other ICU patients, and examined the risk within subgroups of ICU patients.
METHODS
We used population-based medical registries to identify all adult patients admitted to an ICU in Denmark from 2005 through 2010, who survived for 90 days after ICU admission. D-AKI was defined as needing acute dialysis at or after ICU admission. Subsequent ESRD was defined as a need for chronic dialysis for more than 90 days or a kidney transplant. We computed the cumulative ESRD risk for patients with D-AKI and for other ICU patients, taking into account death as a competing risk, and computed hazard ratios (HRs) using a Cox model adjusted for potential confounders.
RESULTS
We identified 107,937 patients who survived for 90 days after ICU admission. Of these, 3,062 (2.8%) had an episode of D-AKI following ICU admission. The subsequent risk of ESRD up to 180 days after ICU admission was 8.5% for patients with D-AKI, compared with 0.1% for other ICU patients. This corresponds to an adjusted HR of 105.6 (95% confidence interval (CI): 78.1 to 142.9). Among patients who survived 180 days after ICU admission without developing ESRD (n = 103,996), the 181-day to 5-year ESRD risk was 3.8% for patients with D-AKI, compared with 0.3% for other ICU patients, corresponding to an adjusted HR of 6.2 (95% CI: 4.7 to 8.1). During the latter period, the impact of AKI was most pronounced in the youngest patients, aged 15 to 49 years (adjusted HR = 12.8, 95% CI: 6.5 to 25.4) and among patients without preexisting chronic kidney disease (adjusted HR = 11.9, 95% CI: 8.5 to 16.8).
CONCLUSION
D-AKI is an important risk factor for ESRD for up to five years after ICU admission.
引言
需要透析的急性肾损伤（D-AKI）在重症监护病房（ICU）患者中很常见。然而，这些患者中终末期肾病（ESRD）风险的随访数据仍然很少。我们评估了D-AKI后ESRD的短期和长期风险，将其与其他ICU患者的风险进行比较，并研究了ICU患者亚组中的风险。
方法
我们使用基于人群的医疗登记系统，识别出2005年至2010年期间入住丹麦ICU且在ICU入院后存活90天的所有成年患者。D-AKI定义为在ICU入院时或之后需要急性透析。随后的ESRD定义为需要慢性透析超过90天或进行肾移植。我们计算了D-AKI患者和其他ICU患者的累积ESRD风险，将死亡作为竞争风险考虑在内，并使用针对潜在混杂因素进行调整的Cox模型计算风险比（HRs）。
结果
我们识别出107,937名在ICU入院后存活90天的患者。其中，3062名（2.8%）在ICU入院后发生了D-AKI。ICU入院后180天内，D-AKI患者的ESRD后续风险为8.5%，而其他ICU患者为0.1%。这对应调整后的HR为105.6（95%置信区间（CI）：78.1至142.9）。在ICU入院后存活180天且未发生ESRD的患者（n = 103,996）中，D-AKI患者在181天至5年的ESRD风险为3.8%，而其他ICU患者为0.3%，对应调整后的HR为6.2（95% CI：4.7至8.1）。在后期，AKI的影响在最年轻的患者（15至49岁）中最为明显（调整后的HR = 12.8，95% CI：6.5至25.4），以及在无既往慢性肾病的患者中（调整后的HR = 11.9，95% CI：8.5至16.8）。
结论
D-AKI是ICU入院后长达五年内ESRD的重要危险因素。
Zotero 插件