McAdams Meredith, Ortiz-Soriano Victor, Jordan Melissa, Armentrout Brian, Vasquez-Rios George, Lima Florence, Sawaya B Peter, Neyra Javier A
Clin Nephrol. 2019 Jul;92(1):15-24. doi: 10.5414/CN109743.
Patients with acute kidney injury requiring renal replacement therapy (AKI-RRT) are at risk of adverse outcomes. Little is known about the incidence of AKI-RRT recovery following hospital discharge. We examine AKI-RRT recovery in hospital survivors discharged to a long-term acute care hospital (LTACH) with need of hemodialysis (HD) for AKI.
Single-center, retrospective cohort study of patients who were hospitalized (08/2015 - 04/2018), suffered from AKI-RRT, and were discharged to an affiliated LTACH with need for HD. Kidney recovery was defined as the patient being alive and no longer requiring HD.
41 patients were included. Mean (SD) age was 61.3 (9.7) years, 63.4% were male, and 90.2% white. At the time of discharge from LTACH, 27 (65.8%) patients had survived and had recovered kidney function (kidney recovery group), 7 had been discharged on HD, and 7 had died (no kidney recovery group, n = 14, 34.2%). In adjusted models, the presence of anemia was associated with a 91% decreased odds of kidney recovery at LTACH discharge. Each additional HD session during LTACH stay had an 18% decreased odds of kidney recovery at LTACH discharge, and each episode of intradialytic hypotension had a 20% decreased odds of kidney recovery at the end of the observation period (median follow-up of 19.0 months).
Almost 2/3 of AKI-RRT patients discharged to an affiliated LTACH with ongoing HD need recovered kidney function. Anemia and the number of HD sessions and intradialytic hypotension episodes were associated with kidney recovery. Future studies should focus on developing risk-stratification tools for kidney recovery and determining best practices to promote recovery in this susceptible population.
需要肾脏替代治疗（AKI-RRT）的急性肾损伤患者面临不良结局的风险。关于出院后AKI-RRT恢复的发生率知之甚少。我们研究了出院至长期急性护理医院（LTACH）且因急性肾损伤需要血液透析（HD）的医院幸存者中AKI-RRT的恢复情况。
对2015年8月至2018年4月住院、患有AKI-RRT且出院至附属LTACH并需要HD的患者进行单中心回顾性队列研究。肾脏恢复定义为患者存活且不再需要HD。
纳入41例患者。平均（标准差）年龄为61.3（9.7）岁，63.4%为男性，90.2%为白人。在从LTACH出院时，27例（65.8%）患者存活且肾功能恢复（肾脏恢复组），7例出院时仍在进行HD，7例死亡（无肾脏恢复组，n = 14，34.2%）。在调整模型中，贫血的存在与LTACH出院时肾脏恢复几率降低91%相关。LTACH住院期间每增加一次HD治疗，LTACH出院时肾脏恢复几率降低18%，透析期间每发生一次低血压，观察期末（中位随访19.0个月）肾脏恢复几率降低20%。
出院至附属LTACH且仍需要HD的AKI-RRT患者中，近2/3恢复了肾功能。贫血、HD治疗次数和透析期间低血压发作与肾脏恢复相关。未来的研究应侧重于开发肾脏恢复的风险分层工具，并确定促进这一易感人群恢复的最佳实践。
