Division of Research, Kaiser Permanente Northern California, Oakland, California.
Department of Epidemiology and Biostatistics and.
Clin J Am Soc Nephrol. 2018 Jun 7;13(6):833-841. doi: 10.2215/CJN.12591117. Epub 2018 May 17.
AKI in the hospital is common and is associated with excess mortality. We examined whether AKI is also independently associated with a higher risk of different cardiovascular events in the first year after discharge.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective analysis of a cohort between 2006 and 2013 with follow-up through 2014, within Kaiser Permanente Northern California. We identified all adults admitted to 21 hospitals who had one or more in-hospital serum creatinine test result and survived to discharge. Occurrence of AKI was on the basis of Kidney Disease: Improving Global Outcomes diagnostic criteria. Potential confounders were identified from comprehensive inpatient and outpatient, laboratory, and pharmacy electronic medical records. During the 365 days after discharge, we ascertained occurrence of heart failure, acute coronary syndromes, peripheral artery disease, and ischemic stroke events from electronic medical records.
Among a matched cohort of 146,941 hospitalized adults, 31,245 experienced AKI. At 365 days postdischarge, AKI was independently associated with higher rates of the composite outcome of hospitalization for heart failure and atherosclerotic events (adjusted hazard ratio [aHR], 1.18; 95% confidence interval [95% CI], 1.13 to 1.25) even after adjustment for demographics, comorbidities, preadmission eGFR and proteinuria, heart failure and sepsis complicating the hospitalization, intensive care unit (ICU) admission, length of stay, and predicted in-hospital mortality. This was driven by an excess risk of subsequent heart failure (aHR, 1.44; 95% CI, 1.33 to 1.56), whereas there was no significant association with follow-up atherosclerotic events (aHR, 1.05; 95% CI, 0.98 to 1.12).
AKI is independently associated with a higher risk of cardiovascular events, especially heart failure, after hospital discharge.
医院获得性急性肾损伤（AKI）较为常见，并与过高的死亡率相关。我们检测了 AKI 是否也与出院后 1 年内不同心血管事件的更高风险独立相关。
设计、设置、参与者和测量方法：我们对 2006 年至 2013 年期间在 Kaiser Permanente Northern California 进行的队列进行了回顾性分析，随访至 2014 年。我们确定了所有在 21 家医院住院且至少有 1 次住院期间血清肌酐检测结果并存活出院的成年人。根据肾脏疾病：改善全球预后（KDIGO）的诊断标准确定 AKI 的发生。通过综合住院和门诊、实验室和药房电子病历确定潜在的混杂因素。在出院后的 365 天内，我们从电子病历中确定心力衰竭、急性冠状动脉综合征、外周动脉疾病和缺血性卒中等事件的发生情况。
在匹配的 146941 名住院成年患者队列中，31245 例发生 AKI。在出院后 365 天，AKI 与心力衰竭和动脉粥样硬化事件住院的复合结局发生率较高独立相关（校正后危险比 [aHR]，1.18；95%置信区间 [95%CI]，1.13 至 1.25），即使在校正了人口统计学因素、合并症、住院前估算肾小球滤过率和蛋白尿、住院时心力衰竭和脓毒症、重症监护病房（ICU）入住、住院时间和预测院内死亡率后也是如此。这是由随后心力衰竭风险增加所驱动的（aHR，1.44；95%CI，1.33 至 1.56），而与后续动脉粥样硬化事件无显著关联（aHR，1.05；95%CI，0.98 至 1.12）。
AKI 与出院后心血管事件的更高风险，尤其是心力衰竭的风险独立相关。
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