Takaya Yoichi, Yoshihara Fumiki, Yokoyama Hiroyuki, Kanzaki Hideaki, Kitakaze Masafumi, Goto Yoichi, Anzai Toshihisa, Yasuda Satoshi, Ogawa Hisao, Kawano Yuhei
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
Heart Vessels. 2016 Jan;31(1):60-5. doi: 10.1007/s00380-014-0572-x. Epub 2014 Aug 24.
Since acute kidney injury (AKI) is not always related to mortality in patients with acute decompensated heart failure (ADHF), the aim of this study was to focus on onset time of AKI and its clinical importance. A total of 371 ADHF patients were included. The impact of AKI (≥ 0.3 mg/dl or 1.5-fold increase in serum creatinine level within 48 h) with early onset (≤ 4 days from admission) or late onset (≥ 5 days from admission) was assessed. AKI occurred in 99 patients, who were divided into two groups according to the median onset time of AKI: 50 with early onset of AKI and 49 with late onset of AKI. The maximum increase in serum creatinine level from admission was greater in patients with late onset of AKI than in patients with early onset of AKI (p = 0.012). Patients with late onset of AKI had a higher 12-month mortality rate than that in patients with early onset of AKI (log-rank test, p = 0.014). Late onset of AKI was an independent predictor of mortality (hazard ratio: 3.39, 95 % confidence interval: 1.84-6.18, p < 0.001). Late onset of AKI was associated with high blood urea nitrogen level at admission and intravenous administration of dobutamine. In conclusion, late onset of AKI related to high blood urea nitrogen level and intravenous administration of dobutamine, but not early onset of AKI, is linked to high mortality rate. Onset time of AKI may be useful for risk stratification of mortality in ADHF patients developing AKI.
由于急性肾损伤（AKI）与急性失代偿性心力衰竭（ADHF）患者的死亡率并不总是相关，本研究的目的是关注AKI的发病时间及其临床重要性。共纳入371例ADHF患者。评估了急性肾损伤（血清肌酐水平在48小时内升高≥0.3mg/dl或升高1.5倍）早发（入院后≤4天）或晚发（入院后≥5天）的影响。99例患者发生了AKI，根据AKI的中位发病时间将其分为两组：50例AKI早发患者和49例AKI晚发患者。AKI晚发患者入院后血清肌酐水平的最大升高幅度大于AKI早发患者（p = 0.012）。AKI晚发患者的12个月死亡率高于AKI早发患者（对数秩检验，p = 0.014）。AKI晚发是死亡率的独立预测因素（风险比：3.39，95%置信区间：1.84 - 6.18，p < 0.001）。AKI晚发与入院时高血尿素氮水平及静脉使用多巴酚丁胺有关。总之，与高血尿素氮水平及静脉使用多巴酚丁胺相关的AKI晚发而非早发与高死亡率相关。AKI的发病时间可能有助于对发生AKI的ADHF患者进行死亡风险分层。
