Omotoso Bolanle A, Abdel-Rahman Emaad M, Xin Wenjun, Ma Jennie Z, Scully Kenneth W, Arogundade Fatiu A, Balogun Rasheed A
Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, PMB 5538, Ile Ife, Osun, Nigeria.
J Nephrol. 2016 Dec;29(6):847-855. doi: 10.1007/s40620-016-0321-6. Epub 2016 Jun 15.
Dialysis-requiring acute kidney injury (D-AKI) is common in hospitalized patients. Many patients survive the immediate post AKI period, thus at risk of suffering long-term sequelae of AKI. Prior studies examining long term outcomes lack non-dialyzed AKI control groups. Without non-dialyzed AKI control group, these studies cannot provide relevant information on long-term risks or benefits associated with dialysis intervention following AKI.
The study cohort comprises of adults admitted to the University of Virginia Medical Center between January 1, 2002 and December 31, 2012 with baseline eGFR ≥60 ml/min per 1.73 m, who developed AKI during hospitalization and survived beyond 30 days of the AKI event. Follow up was done until MACE, death or through Dec 31, 2013 (n = 11,779). AKI was defined according to KDIGO definition. MACE was defined as subsequent admission for Myocardial Infarction (MI), cerebrovascular disease (CVD) and heart failure using ICD 9-CM codes. The date of MACE was defined as the date of the first qualifying event. Demographic and premorbid clinical variables were used to generate propensity score. Patients who had temporary dialysis were matched with those managed conservatively according to propensity score in a ratio of 1:3.
After the propensity score match, the adjusted hazard ratio for MACE, all-cause mortality and composite end point "all-cause mortality or MACE" in dialyzed versus non dialyzed patients were 1.081 (95 % CI 0.848-1.378), 1.107 (95 % CI 0.869-1.410) and 1.107 (95 % CI 0.880-1.307), respectively.
Management of AKI with temporary dialysis in hospitalized patients with baseline eGFR of ≥60 ml/min per 1.73 m was NOT associated with an increased risk for subsequent admission for MACE or all-cause mortality. Clinicians may not need to worry that the dialysis procedure itself may confer additional risk for long-term MACE and all-cause mortality in AKI patients with normal pre-hospitalization GFR.
需要透析的急性肾损伤（D-AKI）在住院患者中很常见。许多患者在急性肾损伤后的急性期存活下来，因此有患急性肾损伤长期后遗症的风险。先前研究长期预后时缺乏未接受透析的急性肾损伤对照组。没有未接受透析的急性肾损伤对照组，这些研究就无法提供关于急性肾损伤后透析干预相关的长期风险或益处的相关信息。
研究队列包括2002年1月1日至2012年12月31日期间入住弗吉尼亚大学医学中心、基线估算肾小球滤过率（eGFR）≥60 ml/（min·1.73 m²）、住院期间发生急性肾损伤且在急性肾损伤事件发生30天后存活的成年人。随访至发生主要不良心血管事件（MACE）、死亡或至2013年12月31日（n = 11779）。急性肾损伤根据改善全球肾脏病预后组织（KDIGO）的定义确定。MACE定义为使用国际疾病分类第九版临床修正本（ICD 9-CM）编码因心肌梗死（MI）、脑血管疾病（CVD）和心力衰竭再次入院。MACE的日期定义为首次符合条件事件的日期。使用人口统计学和病前临床变量生成倾向评分。接受临时透析的患者与保守治疗的患者按倾向评分以1:3的比例匹配。
倾向评分匹配后，透析患者与未透析患者相比，MACE、全因死亡率和复合终点“全因死亡率或MACE”的调整后风险比分别为1.081（95%可信区间0.848 - 1.378）、1.107（95%可信区间0.869 - 1.410）和1.107（95%可信区间0.880 - 1.307）。
对于基线eGFR≥60 ml/（min·1.73 m²）的住院急性肾损伤患者，采用临时透析治疗与随后因MACE再次入院或全因死亡率增加无关。临床医生无需担心透析程序本身可能给住院前肾小球滤过率正常的急性肾损伤患者带来长期MACE和全因死亡率的额外风险。
