Cheng Xiaoyan, Wu Buyun, Liu Yun, Mao Huijuan, Xing Changying
Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Intensive Care Unit, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China.
BMC Nephrol. 2017 Jun 24;18(1):203. doi: 10.1186/s12882-017-0622-6.
Acute kidney injury (AKI) places a heavy burden on the healthcare system in China and is usually misdiagnosed. However, there are limited studies that have described the epidemiology and diagnosis of AKI in China. The aim of this study was to describe the incidence and diagnosis of AKI in hospitalized adult patients in a tertiary teaching hospital in southeast China.
All adult patients hospitalized from October 1, 2013 to September 30, 2014 in the First Affiliated Hospital of Nanjing Medical University were screened using the Lab Administration Network. AKI definition and staging were based on the KDIGO AKI criteria. Demographic characteristics, laboratory examination, clinical data, and clinical outcomes of AKI patients were recorded and analyzed.
The incidence of AKI was 1.6% (1401/87196). The 30-day mortality was 35.3%. AKI stage 1, 2, 3 and RRT accounted for 38.0% (532/1401), 22.0% (309/1401), 40.0% (560/1401), and 16.3% (228/1401) of patients, respectively. The Renal, other Internal Medicine, Surgery, and ICU Departments accounted for 7.4%, 37.1%, 30.1%, and 25.4% of AKI patients, respectively. The timely diagnosis rate, delayed diagnosis rate, and missed diagnosis rate were 44% (616/1401), 3.3% (46/1401), and 52.7% (739/1401), respectively. Patients hospitalized in the Renal Department had the highest AKI diagnosis rate (89.3%, 88/103), while missed diagnosis rate of the surgical patients was as high as 75.1% (317/422). Multivariable logistic regression analysis indicated that presence of tumors, higher serum albumin, and AKI stage 1 were associated with failure to timely diagnose AKI, whereas presence of chronic kidney disease, oliguria, higher blood urea nitrogen, and greater number of organ failures correlated with earlier diagnosis.
AKI was characterized by a high incidence, high short-term mortality, and high missed diagnosis rate in hospitalized adult patients in our hospital. Interventions for improving diagnosis of AKI are urgently needed.
急性肾损伤（AKI）给中国医疗系统带来沉重负担，且常被误诊。然而，描述中国AKI流行病学和诊断情况的研究有限。本研究旨在描述中国东南部一家三级教学医院住院成年患者中AKI的发病率及诊断情况。
使用实验室管理网络对2013年10月1日至2014年9月30日在南京医科大学第一附属医院住院的所有成年患者进行筛查。AKI的定义和分期基于KDIGO AKI标准。记录并分析AKI患者的人口统计学特征、实验室检查、临床资料及临床结局。
AKI发病率为1.6%（1401/87196）。30天死亡率为35.3%。AKI 1期、2期、3期及接受肾脏替代治疗（RRT）的患者分别占患者总数的38.0%（532/1401）、22.0%（309/1401）、40.0%（560/1401）及16.3%（228/1401）。肾脏科、其他内科、外科及重症监护病房（ICU）的AKI患者分别占7.4%、37.1%、30.1%及25.4%。及时诊断率、延迟诊断率及漏诊率分别为44%（616/1401）、3.3%（46/1401）及52.7%（739/1401）。肾脏科住院患者的AKI诊断率最高（89.3%，88/103），而外科患者的漏诊率高达75.1%（317/422）。多变量逻辑回归分析表明，存在肿瘤、较高的血清白蛋白及AKI 1期与AKI未及时诊断相关，而存在慢性肾脏病、少尿、较高的血尿素氮及更多的器官功能衰竭与较早诊断相关。
我院住院成年患者中AKI具有发病率高、短期死亡率高及漏诊率高的特点。迫切需要采取干预措施以改善AKI的诊断。
