Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN, USA.
Academic Health Center-Information Systems, University of Minnesota, Minneapolis, MN, USA.
Nephrol Dial Transplant. 2019 Mar 1;34(3):493-501. doi: 10.1093/ndt/gfy036.
Acute kidney injury (AKI) has been extensively studied in hospital settings. Limited data exist regarding outcomes for patients with outpatient AKI who are not subsequently admitted. We investigated whether outpatient AKI, defined by a 50% increase in creatinine (Cr), is associated with increased mortality and renal events.
In this retrospective study, outpatient serum Cr values from adults receiving primary care at a health system during an 18-month exposure period were used to categorize patients into one of five groups (no outpatient AKI, outpatient AKI with recovery, outpatient AKI without recovery, outpatient AKI without repeat Cr and no Cr). Principal outcomes of all-cause mortality and renal events (50% decline in estimated glomerular filtration rate to <30 mL/min/1.73 m2) were examined using Cox proportional hazards models.
Among 384 869 eligible patients, 51% had at least one Cr measured during the exposure period. Outpatient AKI occurred in 1.4% of patients while hospital AKI occurred in only 0.3% of patients. The average follow-up was 5.3 years. Outpatient AKI was associated with an increased risk of all-cause mortality {adjusted hazard ratio [aHR] 1.90 [95% confidence interval (CI) 1.76-2.06]} and results were consistent across all AKI groups. Outpatient AKI was also associated with an increased risk of renal events [aHR 1.33 (95% CI 1.11-1.59)], even among those who recovered.
Outpatient AKI is more prevalent than inpatient AKI and is a risk factor for all-cause mortality and renal events, even among those who recover kidney function. Further research is necessary to determine risk factors and identify strategies for preventing outpatient AKI.
急性肾损伤（AKI）在医院环境中得到了广泛研究。关于未住院的门诊 AKI 患者的结局，仅有有限的数据。我们研究了门诊 AKI（定义为肌酐（Cr）增加 50%）是否与死亡率和肾脏事件增加相关。
在这项回顾性研究中，使用在 18 个月暴露期内在医疗系统接受初级保健的成年人的门诊血清 Cr 值将患者分为五组之一（无门诊 AKI、门诊 AKI 恢复、门诊 AKI 未恢复、门诊 AKI 无重复 Cr 且无 Cr）。使用 Cox 比例风险模型检查全因死亡率和肾脏事件（估计肾小球滤过率下降 50%至<30 mL/min/1.73 m2）的主要结局。
在 384869 名合格患者中，51%至少有一次在暴露期内测量了 Cr。门诊 AKI 发生在 1.4%的患者中，而住院 AKI 仅发生在 0.3%的患者中。平均随访时间为 5.3 年。门诊 AKI 与全因死亡率增加相关（调整后的危险比 [aHR] 1.90 [95%置信区间 1.76-2.06]），并且在所有 AKI 组中结果一致。门诊 AKI 也与肾脏事件的风险增加相关（aHR 1.33 [95%置信区间 1.11-1.59]），即使在那些恢复肾功能的患者中也是如此。
门诊 AKI 比住院 AKI 更为普遍，是全因死亡率和肾脏事件的危险因素，即使在那些恢复肾功能的患者中也是如此。需要进一步研究以确定风险因素并确定预防门诊 AKI 的策略。
