Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan, †Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
Clin J Am Soc Nephrol. 2014 Mar;9(3):457-61. doi: 10.2215/CJN.04120413. Epub 2013 Dec 5.
The epidemiology of AKI and CKD has been described. However, the epidemiology of progressively worsening kidney function (subacute kidney injury [s-AKI]) developing over a longer time frame than defined for AKI (7 days), but shorter than defined for CKD (90 days), is completely unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective study used a hospital laboratory and admission database. Adult patients admitted to a teaching hospital in Tokyo, Japan, between April 1, 2008, and October 31, 2011, were included. s-AKI was classified into three grades of severity (mild, moderate, severe) in accordance with the Risk, Injury, and Failure categories of the Risk, Injury, Failure, Risk, Loss, and ESRD classification, but did not use its time frame. Kidney injury (AKI and s-AKI) occurring during each hospital stay was identified, and logistic regression analysis was performed to assess their effect on hospital mortality.
Of 56,567 patients admitted to the hospital during the study period, 49,518 were included. Of these, 87.8% had no evidence of kidney dysfunction, 11.0% had AKI, and 1.1% had s-AKI. Patients with s-AKI had mild renal dysfunction in 82.7% of cases, moderate in 12.1%, and severe in 5.0%. Worsening s-AKI category was linearly correlated with hospital mortality, as previously described for AKI (no injury: 1.2%, mild: 6.5%, moderate: 12.9%, severe: 20.7%). Although mortality (8.0% versus 17.5%) and need for renal replacement therapy (0.2% versus 2.2%) were lower in patients with s-AKI than in those with AKI, multivariable regression analysis confirmed that s-AKI was an independent risk factor for hospital mortality (odds ratio (OR), 5.44; 95% confidence interval [95% CI], 3.89 to 7.44); the OR with AKI was 14.8 (95% CI, 13.2 to 16.7).
Close to 1% of hospitalized patients develop s-AKI. This condition is independently associated with increased hospital mortality, and the risk for death increases with s-AKI severity. Patients with s-AKI had a better outcome and were less likely to require renal replacement therapy than patients with AKI.
急性肾损伤（AKI）和慢性肾脏病（CKD）的流行病学已得到描述。然而，逐渐恶化的肾功能（亚急性肾损伤[s-AKI]）的流行病学完全未知，这种情况的发生时间比 AKI 的定义（7 天）长，但比 CKD 的定义（90 天）短。
本回顾性研究使用了医院实验室和入院数据库。纳入 2008 年 4 月 1 日至 2011 年 10 月 31 日期间在日本东京一所教学医院住院的成年患者。s-AKI 按 Risk、Injury、Failure 分类的 Risk、Injury、Failure、Risk、Loss、和 ESRD 分类中的严重程度（轻度、中度、重度）分为三个等级，但不使用其时间框架。确定每个住院期间发生的肾损伤（AKI 和 s-AKI），并进行逻辑回归分析以评估其对住院死亡率的影响。
在研究期间住院的 56567 名患者中，有 49518 名患者被纳入研究。其中，87.8%的患者无肾功能障碍，11.0%的患者有 AKI，1.1%的患者有 s-AKI。s-AKI 患者中，82.7%为轻度肾功能障碍，12.1%为中度肾功能障碍，5.0%为重度肾功能障碍。与 AKI 相同（无损伤：1.2%，轻度：6.5%，中度：12.9%，重度：20.7%），s-AKI 严重程度类别恶化与住院死亡率呈线性相关。虽然 s-AKI 患者的死亡率（8.0%比 17.5%）和需要肾脏替代治疗的比例（0.2%比 2.2%）低于 AKI 患者，但多变量回归分析证实 s-AKI 是住院死亡率的独立危险因素（优势比[OR]，5.44；95%置信区间[95%CI]，3.89 至 7.44）；AKI 的 OR 为 14.8（95%CI，13.2 至 16.7）。
接近 1%的住院患者发生 s-AKI。这种情况与住院死亡率增加独立相关，且随着 s-AKI 严重程度的增加，死亡风险增加。与 AKI 患者相比，s-AKI 患者的预后更好，且不太需要肾脏替代治疗。
