Department of Renal Medicine, Academia, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
Health Services Research Unit, Bachelor of Nursing, University of Sydney, Singapore General Hospital, Singapore, Singapore.
BMC Nephrol. 2019 Jul 26;20(1):282. doi: 10.1186/s12882-019-1466-z.
Acute kidney injury (AKI) is a major global health problem. We aim to evaluate the epidemiology, risk factors and outcomes of AKI episodes in our single centre.
We prospectively identified 422 AKI and acute on chronic kidney disease episodes in 404 patients meeting KDIGO definitions using electronic medical records and clinical data from 15th July to 22nd October 2016, excluding patients with baseline estimated GFR (eGFR) of < 15 mL/min. Patients were followed up till 6 months after AKI diagnosis.
The mean age was 65.8 ± 14.1. Majority of patients were male (58.2%) of Chinese ethnicity (68.8%). One hundred and thirty-two patients (32.6%) were diagnosed in acute care units. Seventy-five percent of patients developed AKI during admission in a non-Renal specialty. Mean baseline eGFR was 50.2 ± 27.7 mL/min. Mean creatinine at AKI diagnosis was 297 ± 161 μmol/L. Renal consultations were initiated at KDIGO Stages 1, 2 and 3 in 58.9, 24.5 and 16.6% of patients, respectively. Three hundred and ten (76.7%) patients had a single etiology of AKI with the 3 most common etiologies of AKI being pre-renal (27.7%), sepsis-associated (25.5%) and ischemic acute tubular necrosis (15.3%). One hundred and nine (27%) patients received acute renal replacement therapy. In-hospital mortality was 20.3%. Six-month mortality post-AKI event was 9.4%. On survival analysis, patients with KDIGO Stage 3 AKI had significantly shorter survival than other stages.
AKI is associated with significant in-hospital to 6-month mortality. This signifies the pressing need for AKI prevention, early detection and intervention in mitigating reversible risk factors in order to optimize clinical outcomes.
急性肾损伤（AKI）是一个全球性的重大健康问题。我们旨在评估我们单中心 AKI 发作的流行病学、风险因素和结局。
我们使用电子病历和 2016 年 7 月 15 日至 10 月 22 日期间的临床数据，前瞻性地确定了符合 KDIGO 定义的 404 例患者中的 422 例 AKI 和急性肾损伤合并慢性肾脏病（CKD）发作，排除了基线估算肾小球滤过率（eGFR）<15 mL/min 的患者。患者在 AKI 诊断后 6 个月进行随访。
平均年龄为 65.8±14.1 岁。大多数患者为男性（58.2%），为华裔（68.8%）。132 例患者（32.6%）在急性护理病房中诊断。75%的患者在非肾脏专科住院期间发生 AKI。基线 eGFR 平均为 50.2±27.7 mL/min。AKI 诊断时肌酐平均为 297±161 μmol/L。KDIGO 分期 1、2 和 3 时，分别有 58.9%、24.5%和 16.6%的患者开始进行肾脏咨询。310 例（76.7%）患者 AKI 的单一病因，AKI 的 3 个最常见病因分别为肾前性（27.7%）、脓毒症相关性（25.5%）和缺血性急性肾小管坏死（15.3%）。109 例（27%）患者接受了急性肾脏替代治疗。院内死亡率为 20.3%。AKI 事件后 6 个月的死亡率为 9.4%。在生存分析中，KDIGO 分期 3 的 AKI 患者的生存时间明显短于其他分期。
AKI 与住院期间和 6 个月死亡率显著相关。这表明迫切需要预防 AKI，早期发现和干预可逆转的危险因素，以优化临床结局。
