Geri Guillaume, Stengel Bénédicte, Jacquelinet Christian, Aegerter Philippe, Massy Ziad A, Vieillard-Baron Antoine
Medico-Surgical ICU, Service de Réanimation médico-chirurgicale, Ambroise Paré Hospital, APHP, 92100, Boulogne Billancourt, France.
Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Univ Paris Sud, Univ Paris Saclay, Villejuif, France.
Ann Intensive Care. 2018 Jul 6;8(1):77. doi: 10.1186/s13613-018-0421-7.
Acute kidney injury (AKI) is frequent and associated with poor outcome in intensive care unit (ICU) patients. Besides the association with short- and long-term mortality, the increased risk of chronic kidney disease (CKD) has been recently highlighted in non-ICU patients. This study aims to describe the incidence and determinants of CKD after AKI and to develop a prediction score for CKD in ICU patients.
Prospective multicenter (n = 17) observational study included 1200 ICU patients who suffered from AKI (defined by an AKIN stage ≥ 1) during their ICU stay and were discharged alive from ICU. Preexisting end-stage renal disease (ESRD) and immunosuppressant treatments are the main exclusion criteria. Patients will be monitored by a nephrologist at day 90 and every year for 3 years. The main outcome is the occurrence of CKD defined by a creatinine-based estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m or renal replacement therapy for ESRD in patients whose eGFR will be normalized (≥ 60 mL/min/1.73 m) at day 90. Secondary outcomes include albuminuria changes, eGFR decline slope and ESRD risk in patients with preexisting CKD, cardiovascular and thromboembolic events and health-related quality of life.
This is the first study prospectively investigating kidney function evolution in ICU patients who suffered from AKI. Albuminuria and eGFR monitoring will allow to identify ICU patients at risk of CKD who may benefit from close surveillance after recovering from AKI. Major patient and AKI-related determinants will be tested to develop a prediction score for CKD in this population. Trial registration ClinicalTrials.gov, NCT03282409. Registered on September 14, 2017.
急性肾损伤（AKI）在重症监护病房（ICU）患者中很常见，且与不良预后相关。除了与短期和长期死亡率相关外，近期非ICU患者中慢性肾脏病（CKD）风险增加也受到了关注。本研究旨在描述AKI后CKD的发病率和决定因素，并开发一种ICU患者CKD的预测评分系统。
前瞻性多中心（n = 17）观察性研究纳入了1200例在ICU住院期间发生AKI（根据急性肾损伤网络（AKIN）分期≥1定义）且从ICU存活出院的患者。主要排除标准为既往终末期肾病（ESRD）和免疫抑制治疗。患者将在第90天由肾病科医生进行监测，并在3年内每年监测一次。主要结局是CKD的发生，定义为基于肌酐的估计肾小球滤过率（eGFR）低于60 mL/min/1.73 m²，或对于第90天时eGFR已恢复正常（≥60 mL/min/1.73 m²）的患者，因ESRD进行肾脏替代治疗。次要结局包括蛋白尿变化、eGFR下降斜率以及既往有CKD患者的ESRD风险、心血管和血栓栓塞事件以及健康相关生活质量。
这是第一项前瞻性研究AKI的ICU患者肾功能演变的研究。蛋白尿和eGFR监测将有助于识别有CKD风险的ICU患者，这些患者在从AKI恢复后可能受益于密切监测。将对主要的患者和AKI相关决定因素进行测试，以开发该人群CKD的预测评分系统。试验注册ClinicalTrials.gov，NCT03282409。于2017年9月14日注册。
