National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom,
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Nephron. 2019;142(2):83-90. doi: 10.1159/000497385. Epub 2019 Mar 21.
Although the epidemiology of acute kidney injury (AKI) has been well described, less is known about recurrent AKI (r-AKI). We undertook a systematic review to identify incidence, risk factors, and outcomes of r-AKI.
MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science were searched, from inception to December 2017, for quantitative studies on adults with AKI, where follow-up included -reporting of r-AKI. Two reviewers independently identified studies and assessed study quality.
From 2,824 citations, 10 cohort studies met inclusion criteria (total patients n = 538,667). There were 2 distinct set of studies; 4 studies assessed r-AKI within the same hospital admission (most were intensive care unit [ICU] patients) and 6 studies assessed postdischarge r-AKI. The median percentage of people developing r-AKI within the same hospital admission was 23.4% (IQR 20.3-27.2%) and postdischarge r-AKI was 31.3% (IQR 26.4-33.7%). A higher Acute Physiology and Chronic Health Evaluation score was associated with increased risk of r-AKI within the same hospital admission in ICU patients. Cardiovascular disease and AKI severity were associated with increased risk of postdischarge r-AKI. R-AKI (within same admission and postdischarge) was associated with worse survival. It was not possible to pool results due to methodological differences across studies, such as varying definitions for AKI and r-AKI, varying length of follow-up and effect measures. Key messages: More representative population-based studies with robust assessment of predictors and consensus definition of r-AKI are needed to identify risk factors and develop risk stratification tools to reduce recurrence and improve outcomes. Systematic Review Registration: CRD42017082668.
尽管急性肾损伤（AKI）的流行病学已得到很好的描述，但对复发性 AKI（r-AKI）的了解较少。我们进行了一项系统评价，以确定 r-AKI 的发病率、危险因素和结局。
从 2017 年 12 月开始，在 MEDLINE、EMBASE、CINAHL、Cochrane、Web of Science 上搜索了有关 AKI 成人的定量研究，随访包括报告 r-AKI。两名评审员独立确定研究并评估研究质量。
从 2824 条引文，10 项队列研究符合纳入标准（总患者 n = 538667）。有两组不同的研究；4 项研究在同一住院期间评估 r-AKI（大多数为重症监护病房 [ICU] 患者），6 项研究评估出院后 r-AKI。同一住院期间 r-AKI 的发生率中位数为 23.4%（IQR 20.3-27.2%），出院后 r-AKI 为 31.3%（IQR 26.4-33.7%）。在 ICU 患者中，急性生理学和慢性健康评估评分较高与同一住院期间 r-AKI 的风险增加相关。心血管疾病和 AKI 严重程度与出院后 r-AKI 的风险增加相关。r-AKI（在同一住院期间和出院后）与生存率降低相关。由于研究之间存在方法学差异，例如 AKI 和 r-AKI 的定义不同、随访时间和效应测量不同，因此无法汇总结果。关键信息：需要进行更多具有代表性的基于人群的研究，对预测因素进行稳健评估，并对 r-AKI 达成共识定义，以确定危险因素并开发风险分层工具，以降低复发率并改善结局。系统评价注册：CRD42017082668。
