Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Ceará, Brazil.
Crit Care. 2017 Nov 18;21(1):280. doi: 10.1186/s13054-017-1873-0.
Although significant advances have been achieved in acute kidney injury (AKI) research following its classification, potential pitfalls can be identified in clinical practice. The nonsteady-state (kinetic) estimated glomerular filtration rate (KeGFR) could add clinical and prognostic information in critically ill patients beyond the current AKI classification system.
This was a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II project. The KeGFR was calculated during the first 7 days of intensive care unit (ICU) stay in 13,284 patients and was correlated with outcomes.
In general, there was not a good agreement between AKI severity and the worst achieved KeGFR. The stepwise reduction in the worst achieved KeGFR conferred an incremental risk of death, rising from 7.0% (KeGFR > 70 ml/min/1.73 m) to 27.8% (KeGFR < 30 ml/min/1.73 m). This stepwise increment in mortality remained in each AKI severity stage. For example, patients with AKI stage 3 who maintained KeGFR had a mortality rate of 16.5%, close to those patients with KeGFR < 30 ml/min/1.73 m but no AKI; otherwise, mortality increased to 40% when both AKI stage 3 and KeGFR < 30 ml/min/1.73 m were present. In relation to another outcome-renal replacement therapy (RRT)-patients with the worst achieved KeGFR < 30 ml/min/1.73 m and KDIGO stage 1/2 had a rate of RRT of less than 10%. However, this rate was 44% when both AKI stage 3 and a worst KeGFR < 30 ml/min/1.73 m were observed. This interaction between AKI and KeGFR was also present when looking at long-term survival.
Both the AKI classification system and KeGFR are complementary to each other. Assessing both AKI stage and KeGFR can help to identify patients at different risk levels in clinical practice.
尽管急性肾损伤 (AKI) 分类后在研究方面取得了重大进展，但在临床实践中仍可能存在潜在的陷阱。非稳态（动力学）估算肾小球滤过率（KeGFR）可在当前 AKI 分类系统之外为危重症患者提供临床和预后信息。
这是一项使用 Multiparameter Intelligent Monitoring in Intensive Care II 项目数据的回顾性分析。在 13284 名患者入住重症监护病房（ICU）的前 7 天内计算 KeGFR，并与结局相关联。
一般来说，AKI 严重程度与最差 KeGFR 之间没有很好的一致性。最差 KeGFR 的逐步降低赋予了死亡的递增风险，从 7.0%（KeGFR>70ml/min/1.73m）上升至 27.8%（KeGFR<30ml/min/1.73m）。这种死亡率的逐步递增在每个 AKI 严重程度阶段都存在。例如，维持 KeGFR 的 AKI 第 3 阶段患者的死亡率为 16.5%，接近 KeGFR<30ml/min/1.73m 但没有 AKI 的患者；否则，当 AKI 第 3 阶段和 KeGFR<30ml/min/1.73m 同时存在时，死亡率增加至 40%。与另一个结局——肾脏替代治疗（RRT）——相比，最差 KeGFR<30ml/min/1.73m 且 KDIGO 第 1/2 阶段的患者 RRT 率不到 10%。然而，当同时存在 AKI 第 3 阶段和最差 KeGFR<30ml/min/1.73m 时，这一比率为 44%。当观察长期生存率时，AKI 和 KeGFR 之间也存在这种相互作用。
AKI 分类系统和 KeGFR 相互补充。评估 AKI 分期和 KeGFR 都可以帮助在临床实践中识别处于不同风险水平的患者。
