Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
Am J Nephrol. 2019;49(3):175-185. doi: 10.1159/000496611. Epub 2019 Jan 30.
The aim of this study was to examine different definitions of renal recovery following postoperative acute kidney injury (AKI) and how these definitions associate with survival and the development and progression of chronic kidney disease (CKD).
This was a retrospective study of all patients who underwent abdominal, cardiothoracic, vascular, or orthopedic surgery at a single university hospital between 1998 and 2015. Recovery of renal function following postoperative AKI was assessed comparing 4 different definitions: serum creatinine (SCr) (i) < 1.1 × baseline, (ii) 1.1-1.25 × baseline, (iii) 1.25-1.5 × baseline, and (iv) > 1.5 × baseline. One-year survival and the development or progression of CKD within 5 years was compared with a propensity score-matched control groups.
In total, 2,520 AKI patients were evaluated for renal recovery. Risk of incident and progressive CKD within 5 years was significantly increased if patients did not achieve a reduction in SCr to < 1.5 × baseline (hazard ratio [HR] 1.50; 95% CI 1.29-1.75) and if renal recovery was limited to a fall in SCr to 1.25-1.5 × baseline (HR 1.32; 95% CI 1.12-1.57) within 30 days. The definition of renal recovery that best predicted survival was a reduction in SCr to < 1.5 × baseline within 30 days. One-year survival of patients whose SCr decreased to < 1.5 × baseline within 30 days was significantly better than that of a propensity score-matched control group that did not achieve renal recovery (85 vs. 71%, p < 0.001).
These findings should be considered when a consensus definition of renal recovery after AKI is established.
本研究旨在探讨术后急性肾损伤（AKI）后肾功能恢复的不同定义，以及这些定义如何与生存以及慢性肾脏病（CKD）的发生和进展相关。
这是一项回顾性研究，纳入了 1998 年至 2015 年期间在一家大学医院接受腹部、心胸、血管或骨科手术的所有患者。通过比较 4 种不同的定义评估术后 AKI 后肾功能的恢复情况：血清肌酐（SCr）（i）<1.1×基线，（ii）1.1-1.25×基线，（iii）1.25-1.5×基线，和（iv）>1.5×基线。通过倾向评分匹配的对照组比较 1 年生存率和 5 年内 CKD 的发生或进展。
共有 2520 例 AKI 患者评估了肾功能恢复情况。如果患者的 SCr 未降至<1.5×基线（风险比 [HR] 1.50；95%置信区间 [CI] 1.29-1.75），或者肾功能恢复仅限于 30 天内 SCr 降至 1.25-1.5×基线（HR 1.32；95% CI 1.12-1.57），则在 5 年内发生和进展性 CKD 的风险显著增加。在 30 天内将 SCr 降低至<1.5×基线是预测生存的最佳肾功能恢复定义。在 30 天内将 SCr 降低至<1.5×基线的患者的 1 年生存率明显优于未实现肾功能恢复的倾向评分匹配对照组（85%比 71%，p<0.001）。
在制定 AKI 后肾功能恢复的共识定义时，应考虑这些发现。
