Safari Saeed, Hashemi Behrouz, Forouzanfar Mohammad Mehdi, Shahhoseini Mehrnoush, Heidari Meysam
Emergency Department, Shohadaye Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.
Emerg (Tehran). 2018;6(1):e30. Epub 2018 May 5.
Elimination of preventable deaths due to acute kidney injury (AKI) in low-income countries by 2025 is an important healthcare goal at the international level. The present study was designed with the aim of evaluating the prevalence and outcome of AKI in patients presenting to emergency department.
The present cross-sectional, retrospective study was performed on patients that presented to the emergency departments of 3 major teaching hospitals, Tehran, Iran, between 2005 and 2015 and were diagnosed with AKI. Patient selection was done using consecutive sampling and required data for this study was extracted by referring to the medical profiles of the patients and filling out a checklist designed for the study.
770 AKI patients with the mean age of 62.72 ± 19.79 (1 - 99) years were evaluation (59.1% male). 690 (89.61%) cases of AKI causes were pre-renal or renal. Among the pre-renal causes, 74 (73.3%) cases were due to different types of shock (p < 0.001). The most common etiologic causes of AKI in pre-renal group were hypotension (57.3%) and renal vascular insufficiency (31.6%). In addition, regarding the renal types, rhabdomyolysis (35.0%), medication (17.5%) and chemotherapy (15.3%) and in post-renal types, kidney stone (34.5%) were the most common etiologic causes. 327 (42.5%) patients needed dialysis and 169 (21.9%) patients died. Sex (p = 0.001), age over 60 years (p = 0.001), blood urea nitrogen level (p < 0.001), hyperkalemia (p < 0.001), metabolic acidosis (p < 0.001), cause of failure (p = 0.001), and type of failure (p = 0.009) were independent risk factors of mortality.
The total prevalence of AKI in emergency department was 315 for each 1000000 population and preventable mortality rate due to AKI was estimated to be 28.2 cases in each 1000000 population. The most important preventable AKI causes in the pre-renal group included shock, sepsis, and dehydration; in the renal group they included rhabdomyolysis and intoxication; and stones in the post-renal group.
到2025年在低收入国家消除因急性肾损伤（AKI）导致的可预防死亡是国际层面一项重要的医疗保健目标。本研究旨在评估急诊科就诊患者中急性肾损伤的患病率及转归情况。
本横断面回顾性研究针对2005年至2015年期间在伊朗德黑兰3家主要教学医院急诊科就诊并被诊断为急性肾损伤的患者开展。采用连续抽样进行患者选择，通过查阅患者病历并填写为本研究设计的检查表来提取所需数据。
共评估了770例急性肾损伤患者，平均年龄为62.72±19.79（1 - 99）岁（男性占59.1%）。690例（89.61%）急性肾损伤病因属于肾前性或肾性。在肾前性病因中，74例（73.3%）由不同类型的休克导致（p<0.001）。肾前性组中急性肾损伤最常见的病因是低血压（57.3%）和肾血管功能不全（31.6%）。此外，在肾性类型中，横纹肌溶解（35.0%）、药物（17.5%）和化疗（15.3%），在肾后性类型中，肾结石（34.5%）是最常见的病因。327例（42.5%）患者需要透析，169例（21.9%）患者死亡。性别（p = 0.001）、60岁以上年龄（p = 0.001）、血尿素氮水平（p<0.001）、高钾血症（p<0.001）、代谢性酸中毒（p<0.001）、衰竭病因（p = 0.001）及衰竭类型（p = 0.009）是死亡的独立危险因素。
急诊科急性肾损伤的总患病率为每100万人口315例，因急性肾损伤导致的可预防死亡率估计为每100万人口28.2例。肾前性组中最重要的可预防急性肾损伤病因包括休克、脓毒症和脱水；肾性组中包括横纹肌溶解和中毒；肾后性组中为结石。
