Carmody J Bryan, Swanson Jonathan R, Rhone Erika T, Charlton Jennifer R
Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia; and.
Department of Pediatrics, Division of Neonatology and.
Clin J Am Soc Nephrol. 2014 Dec 5;9(12):2036-43. doi: 10.2215/CJN.05190514. Epub 2014 Oct 3.
AKI is associated with both increased short-term morbidity and mortality and greater long-term risk for CKD. This study determined the prevalence of AKI among very low birth weight infants using a modern study definition, evaluated the frequency of AKI diagnosis reporting in the discharge summary, and determined whether infants were referred to a pediatric nephrologist for AKI follow-up.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Records of very low birth weight infants admitted to a level IV neonatal intensive care unit from 2008 to 2011 were reviewed. AKI was classified using the Kidney Disease: Improving Global Outcomes definition modified to include only serum creatinine.
AKI occurred in 39.8% of 455 infants; 75 (16.5%) infants experienced multiple episodes of AKI, and 8 (2%) infants were discharged with an abnormal last creatinine. Updated clinical risk index for babies score >10 (odds ratio, 12.9; 95% confidence interval, 7.8 to 21.4) and gestational age <28 weeks (odds ratio, 10.6; 95% confidence interval, 6.8 to 16.7) were strongly associated with AKI in univariate analyses. AKI was associated with increased mortality (odds ratio, 4.0; 95% confidence interval, 1.4 to 11.5) and length of stay (11.7 hospital days; 95% confidence interval, 5.1 to 18.4), even after accounting for gestational age, birth weight, and updated clinical risk index for babies score. AKI was recorded in the discharge summary for only 13.5% of AKI survivors. No infants were referred to a nephrologist for AKI follow-up.
AKI occurred in 40% of very low birth weight infants and was concentrated in the most premature and severely ill infants. One in six infants experienced multiple episodes of AKI, and a small number of infants was discharged with an elevated serum creatinine. Reporting a history of AKI in the discharge summary occurred infrequently, and referral to a nephrologist for AKI follow-up did not occur, highlighting areas for quality improvement.
急性肾损伤（AKI）与短期发病率和死亡率增加以及慢性肾脏病（CKD）的长期风险升高均相关。本研究采用现代研究定义确定极低出生体重儿中AKI的患病率，评估出院小结中AKI诊断报告的频率，并确定婴儿是否因AKI随访而被转诊至儿科肾病专家处。
设计、地点、参与者及测量方法：回顾了2008年至2011年入住四级新生儿重症监护病房的极低出生体重儿的记录。AKI采用肾脏病：改善全球预后定义进行分类，该定义经修改后仅纳入血清肌酐。
455例婴儿中有39.8%发生AKI；75例（16.5%）婴儿经历多次AKI发作，8例（2%）婴儿出院时最后一次肌酐值异常。单因素分析中，更新的婴儿临床风险指数评分>10（比值比，12.9；95%置信区间，7.8至21.4）和胎龄<28周（比值比，10.6；95%置信区间，6.8至16.7）与AKI密切相关。即使在考虑胎龄、出生体重和更新的婴儿临床风险指数评分后，AKI仍与死亡率增加（比值比，4.0；95%置信区间，1.4至11.5）和住院时间延长（11.7个住院日；95%置信区间，5.1至18.4）相关。仅13.5%的AKI存活者在出院小结中记录了AKI。没有婴儿因AKI随访被转诊至肾病专家处。
40%的极低出生体重儿发生AKI，且集中在最早产和病情最严重的婴儿中。六分之一的婴儿经历多次AKI发作，少数婴儿出院时血清肌酐升高。出院小结中很少报告AKI病史，且未发生因AKI随访而转诊至肾病专家处的情况，突出了需要改进的方面。
