Fagugli Riccardo Maria, Patera Francesco, Battistoni Sara, Mattozzi Francesca, Tripepi Giovanni
S.C.Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria di Perugia, S.Andrea delle Fratte, 06123, Perugia, Italy,
J Nephrol. 2015 Jun;28(3):339-49. doi: 10.1007/s40620-014-0114-8. Epub 2014 Jun 17.
Evidence regarding hospital-based acute kidney injury (AKI) reveals a continuous increase in incidence over the years, at least in intensive care units (ICU). Fewer reports are available for non critically-ill patients admitted to general or specialist wards other than ICU (non-ICU). The consequence of greater incidence is an increase in therapies such as dialysis; but how the health care organization deals with this problem is not clearly known. Here we quantified the incidence of dialysis-requiring AKI (AKI-D) among patients admitted to a University Hospital which serves a population of 354,000 inhabitants. Between 2007 and 2012, the incidence of AKI-D increased from 209 to 410 per million population (pmp)/year; age of patients and cardiovascular comorbid pathologies also increased. AKI-D was more frequent in non-ICU and 32% of patients were admitted to ICU. Considering the site of treatment of non-ICU patients, in 2007 the ratio of patients admitted to non-ICU wards apart from Nephrology to those admitted to Nephrology was 1:1, but in 2012 the ratio increased to 2.4:1 (p < 0.05). The complexity of acute disease, measured with the New Simplified Acute Physiology Score (SAPS II), did not reveal differences over the years. The number of dialysis treatments/year increased by 82%, and the total hours/year increased by 86%. Low-efficiency daily dialysis was performed in 52.4% of patients admitted to ICU, but dialysis sessions longer than 8 h were performed in only 40% of cases. Overall, 6-year mortality was 48.8%, without significant differences over the years. Mortality in ICU was 65.6%, and in non-ICU 41.2% (p < 0.001). Dialysis treatments needed to be continued after hospital discharge in 21% of patients. We conclude that dialysis-requiring AKI is becoming more common, and that two-thirds of patients are admitted as non-ICU: in these patients, during the last year of the study, the treatment site was more frequently in non-ICUs other than Nephrology. Over the 6-year period, the local healthcare organization had to dispense 80% more dialysis treatments/year in terms of total number and hours of treatment. One-fifth of surviving patients needed to continue dialysis after hospital discharge. Our data highlight the public health importance of AKI and the need for adequate resources for Nephrology.
有关医院获得性急性肾损伤（AKI）的证据显示，这些年来其发病率持续上升，至少在重症监护病房（ICU）是这样。对于入住普通病房或ICU以外的专科病房（非ICU）的非重症患者，相关报道较少。发病率上升的后果是诸如透析等治疗手段的增加；但医疗保健机构如何应对这一问题尚不清楚。在此，我们对一家服务于35.4万居民的大学医院收治患者中需要透析的急性肾损伤（AKI-D）的发病率进行了量化。2007年至2012年期间，AKI-D的发病率从每百万人口每年209例增至410例（pmp）；患者年龄及心血管合并症也有所增加。AKI-D在非ICU更为常见，32%的患者入住ICU。考虑到非ICU患者的治疗地点，2007年入住除肾脏病科以外的非ICU病房的患者与入住肾脏病科的患者比例为1:1，但在2012年该比例增至2.4:1（p<0.05）。用新简化急性生理学评分（SAPS II）衡量的急性疾病复杂性在这些年里未显示出差异。每年的透析治疗次数增加了82%，每年的总时长增加了86%。入住ICU的患者中有52.4%接受了低效每日透析，但仅40%的病例透析时长超过8小时。总体而言，6年死亡率为48.8%，这些年里无显著差异。ICU的死亡率为65.6%，非ICU为41.2%（p<0.001）。21%的患者出院后仍需继续透析治疗。我们得出结论，需要透析的AKI正变得越来越常见，三分之二的患者以非ICU患者身份入院：在这些患者中，在研究的最后一年，治疗地点更频繁地是在除肾脏病科以外的非ICU。在这6年期间，当地医疗保健机构每年必须在透析治疗的总数和时长方面多提供80%的透析治疗。五分之一的存活患者出院后需要继续透析。我们的数据凸显了AKI对公共卫生的重要性以及肾脏病科获得充足资源的必要性。
