Thongprayoon Charat, Cheungpasitporn Wisit, Mao Michael A, Sakhuja Ankit, Erickson Stephen B
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
Int J Clin Pract. 2018 Apr;72(4):e13057. doi: 10.1111/ijcp.13057. Epub 2018 Jan 5.
The risk of acute kidney injury (AKI) development among hospitalised patients with elevated calcium levels on admission remains unclear. The aim of this study was to assess the risk of AKI in hospitalised patients stratified by various admission serum calcium levels.
This is a single-centre retrospective study conducted at a tertiary referral hospital. All hospitalised adult patients who had admission calcium levels available between 2009 and 2013 were enrolled. Admission calcium was categorised based on its distribution into six groups (≤7.9, 8.0-8.4, 8.5-8.9, 9.0-9.4, 9.5-9.9, and ≥10.0 mg/dL). The primary outcome was hospital-acquired AKI. Logistic regression analysis was performed to obtain the odds ratio of AKI for various admission calcium strata using calcium levels of 8.0-8.4 mg/dL (lowest incidence of AKI) as the reference group.
A total of 12 784 patients were studied. Hospital-acquired AKI occurred in 1779 (13.9%) patients. The incidence of AKI among patients with admission calcium ≤7.9, 8.0-8.4, 8.5-8.9, 9.0-9.4, 9.5-9.9 and ≥10 mg/dL was 14.7%, 11.7%, 11.8%, 14.6%, 15.8% and 17.3%, respectively. After adjusting for potential confounders, admission calcium levels ≤7.9, 9.0-9.4, 9.5-9.9 and ≥10 mg/dL were associated with increased risk of AKI with odds ratios of 1.36 (95%CI 1.08-1.72), 1.29 (95%CI 1.08-1.56), 1.38 (95%CI 1.14-1.68) and 1.51 (95%CI 1.19-1.91), respectively.
Admission hypocalcaemia and hypercalcaemia are associated with an increased risk for hospital acquired AKI. Patients with admission hypercalcaemia (≥10 mg/dL) carry a 1.51-fold risk for AKI development during hospitalisation.
入院时钙水平升高的住院患者发生急性肾损伤（AKI）的风险尚不清楚。本研究的目的是评估根据入院时不同血清钙水平分层的住院患者发生AKI的风险。
这是一项在三级转诊医院进行的单中心回顾性研究。纳入了2009年至2013年间有入院钙水平记录的所有成年住院患者。根据钙水平分布将入院钙分为六组（≤7.9、8.0 - 8.4、8.5 - 8.9、9.0 - 9.4、9.5 - 9.9和≥10.0mg/dL）。主要结局是医院获得性AKI。进行逻辑回归分析，以8.0 - 8.4mg/dL（AKI发生率最低）的钙水平作为参照组，获得不同入院钙分层发生AKI的比值比。
共研究了12784例患者。1779例（13.9%）患者发生了医院获得性AKI。入院钙≤7.9、8.0 - 8.4、8.5 - 8.9、9.0 - 9.4、9.5 - 9.9和≥10mg/dL的患者中AKI的发生率分别为14.7%、11.7%、11.8%、14.6%、15.8%和17.3%。在对潜在混杂因素进行校正后，入院钙水平≤7.9、9.0 - 9.4、9.5 - 9.9和≥10mg/dL与AKI风险增加相关，比值比分别为1.36（95%CI 1.08 - 1.72）、1.29（95%CI 1.08 - 1.56）、1.38（95%CI 1.14 - 1.68）和1.51（95%CI 1.19 - 1.91）。
入院时低钙血症和高钙血症与医院获得性AKI风险增加相关。入院时高钙血症（≥10mg/dL）的患者在住院期间发生AKI的风险是1.51倍。
