Division of Nephrology, Department of Internal Medicine.
J Am Soc Nephrol. 2014 Mar;25(3):595-605. doi: 10.1681/ASN.2013060610. Epub 2014 Feb 6.
The incidence rate of AKI in hospitalized patients is increasing. However, relatively little attention has been paid to the association of AKI with long-term risk of adverse coronary events. Our study investigated hospitalized patients who recovered from de novo dialysis-requiring AKI between 1999 and 2008 using patient data collected from inpatient claims from Taiwan National Health Insurance. We used Cox regression with time-varying covariates to adjust for subsequent CKD and ESRD after discharge. Results were further validated by analysis of a prospectively constructed database. Among 17,106 acute dialysis patients who were discharged, 4869 patients recovered from dialysis-requiring AKI (AKI recovery group) and were matched with 4869 patients without AKI (non-AKI group). The incidence rates of coronary events were 19.8 and 10.3 per 1000 person-years in the AKI recovery and non-AKI groups, respectively. AKI recovery associated with higher risk of coronary events (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.36 to 2.04) and all-cause mortality (HR, 1.67; 95% CI, 1.57 to 1.79) independent of the effects of subsequent progression to CKD and ESRD. The risk levels of de novo coronary events after hospital discharge were similar in patients with diabetes alone and patients with AKI alone (P=0.23). Our results reveal that AKI with recovery associated with higher long-term risks of coronary events and death in this cohort, suggesting that AKI may identify patients with high risk of future coronary events. Enhanced postdischarge follow-up of renal function of patients who have recovered from temporary dialysis may be warranted.
住院患者急性肾损伤（AKI）的发病率正在上升。然而，人们相对较少关注 AKI 与长期不良冠状动脉事件风险之间的关联。我们的研究使用从台湾全民健康保险住院理赔中收集的患者数据，调查了 1999 年至 2008 年期间新发生需要透析的 AKI 并已康复的住院患者。我们使用具有时变协变量的 Cox 回归来调整出院后随后发生的慢性肾脏病（CKD）和终末期肾病（ESRD）。结果通过对前瞻性构建的数据库进行分析进一步验证。在 17106 名接受急性透析的患者中，有 4869 名患者从需要透析的 AKI 中康复（AKI 康复组），并与 4869 名没有 AKI 的患者相匹配（非 AKI 组）。AKI 康复组和非 AKI 组的冠状动脉事件发生率分别为每 1000 人年 19.8 和 10.3。AKI 康复与更高的冠状动脉事件风险相关（危险比 [HR]，1.67；95%置信区间 [95%CI]，1.36 至 2.04）和全因死亡率（HR，1.67；95%CI，1.57 至 1.79），独立于随后进展为 CKD 和 ESRD 的影响。与单独患有糖尿病的患者相比，单独患有 AKI 的患者出院后新发冠状动脉事件的风险水平相似（P=0.23）。我们的研究结果表明，该队列中 AKI 伴有康复与更高的长期冠状动脉事件和死亡风险相关，这表明 AKI 可能可以识别出未来发生冠状动脉事件风险较高的患者。对已从临时透析中康复的患者的肾功能进行强化的出院后随访可能是必要的。
