Wu Pei-Chen, Wu Chih-Jen, Lin Cheng-Jui, Wu Vin-Cent
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan;
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan; Graduate Institute of Medical Sciences and Department of Pharmacology, College of Medicine, Taipei Medical University, Taipei, Taiwan;
Clin J Am Soc Nephrol. 2015 Mar 6;10(3):353-62. doi: 10.2215/CJN.01240214. Epub 2014 Dec 19.
There are few reports on temporary dialysis-requiring AKI as a risk factor for future upper gastrointestinal bleeding (UGIB). This study sought to explore the long-term association between dialysis-requiring AKI and UGIB.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Patients who recovered from dialysis-requiring AKI and matched controls were selected from hospitalized patients age ≥18 years between 1998 and 2006. The cumulative incidences of long-term de novo UGIB were calculated, and the risk factors of UGIB and mortality were identified using time-varying Cox proportional hazard models adjusted for subsequent CKD and ESRD after AKI.
A total of 4565 AKI-recovery patients and the same number of matched patients without AKI were analyzed. After a median follow-up time of 2.33 years (interquartile range, 0.97-4.81 years), the incidence rates of UGIB were 50 (by stringent criterion) and 69 (by lenient criterion) per 1000 patient-years in the AKI-recovery group and 31 (by stringent criterion) and 48 (by lenient criterion) per 1000 patient-years in the non-AKI group (both P<0.001). When compared with patients in the non-AKI group, the multivariate hazard ratio (HR) for UGIB was 1.30 (95% confidence interval [95% CI], 1.14 to 1.48) for dialysis-requiring AKI, 1.83 (95% CI, 1.53 to 2.20) for time-varying CKD, and 2.31 (95% CI, 1.92 to 2.79) for time-varying ESRD (all P<0.001). Finally, the risk for long-term mortality increased after UGIB (HR, 1.24; 95% CI, 1.12 to 1.38) and dialysis-requiring AKI (HR, 1.66; 95% CI, 1.54 to 1.78).
Recovery from dialysis-requiring AKI was associated with future UGIB and mortality.
关于需要临时透析的急性肾损伤（AKI）作为未来上消化道出血（UGIB）风险因素的报道较少。本研究旨在探讨需要透析的AKI与UGIB之间的长期关联。
设计、设置、参与者与测量：这项全国性队列研究使用了台湾国民健康保险研究数据库的数据。从1998年至2006年期间年龄≥18岁的住院患者中选取从需要透析的AKI中康复的患者及匹配的对照组。计算长期新发UGIB的累积发病率，并使用随时间变化的Cox比例风险模型确定UGIB和死亡率的风险因素，该模型针对AKI后的后续慢性肾脏病（CKD）和终末期肾病（ESRD）进行了调整。
共分析了4565例AKI康复患者和相同数量的无AKI匹配患者。在中位随访时间2.33年（四分位间距，0.97 - 4.81年）后，AKI康复组UGIB的发病率分别为每1000患者年50例（严格标准）和69例（宽松标准），非AKI组分别为每1000患者年31例（严格标准）和48例（宽松标准）（均P<0.001）。与非AKI组患者相比，需要透析的AKI发生UGIB的多变量风险比（HR）为1.30（95%置信区间[95%CI]，1.14至1.48），随时间变化的CKD为1.83（95%CI，1.53至2.20），随时间变化的ESRD为2.31（95%CI，1.92至2.79）（均P<0.001）。最后，UGIB（HR，1.24；95%CI，1.12至1.38）和需要透析的AKI（HR，1.66；95%CI，1.54至1.78）后长期死亡风险增加。
从需要透析的AKI中康复与未来UGIB和死亡率相关。
