Division of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Division of Nephrology, Department of Medicine, University of California, San Francisco, 533 Parnassus Ave, U404, Box 0532, San Francisco, CA, 94143-0532, USA.
BMC Nephrol. 2019 Sep 2;20(1):342. doi: 10.1186/s12882-019-1483-y.
Approximately 4-6% of incident end stage renal disease (ESRD) patients in the U.S. recover enough kidney function to discontinue dialysis but there is considerable geographic variation. We undertook this study to investigate whether state-level variations in renal recovery among incident ESRD patients correlated with state-level variations in incidence of acute kidney injury requiring dialysis (AKI-D).
We conducted a national cross-sectional ecological study at the state-level using data from State Inpatient Databases and U.S. Renal Data System. All hospital admissions and all ESRD patients in 18 US states (AZ, AR, CA, FL, IA, KY, MA, MD, MI, NJ, NM, NY, NV, OR, RI, SC, VT, and WA) were included. Correlation between AKI-D incidence and rate of renal recovery across states was determined using Pearson's r (overall and in subgroups). We also calculated partial correlations adjusted for sex and age.
AKI-D incidence ranged from 99.0 per million population (pmp) in Vermont to 490.4 pmp in Nevada. Rate of renal recovery among incident ESRD patients ranged from 8.8 pmp in Massachusetts to 29.3 pmp in Florida. A positive correlation between AKI-D incidence and rate of renal recovery among incident ESRD patients at state level was found overall (unadjusted r = 0.67; p = 0.002) and in age, sex, and race subgroups. The overall correlation persisted after adjusting for age (adjusted r = 0.62; p < 0.001) and sex (adjusted r = 0.65; p < 0.001).
Our findings suggest that AKI-D incidence is an important driver of renal recovery rates among incident ESRD patients.
在美国，约有 4-6%的新发终末期肾病 (ESRD) 患者的肾功能恢复到足以停止透析的程度，但存在相当大的地域差异。我们进行这项研究是为了调查新发 ESRD 患者的肾脏恢复率是否与需要透析的急性肾损伤 (AKI-D) 的发生率在各州之间的变化相关。
我们在州一级进行了一项全国性的横断面生态研究，使用了来自州住院数据库和美国肾脏数据系统的数据。包括美国 18 个州（亚利桑那州、阿肯色州、加利福尼亚州、佛罗里达州、爱荷华州、肯塔基州、马萨诸塞州、马里兰州、密歇根州、新泽西州、新墨西哥州、纽约州、内华达州、俄勒冈州、罗得岛州、南卡罗来纳州、佛蒙特州和华盛顿州）的所有住院患者和所有 ESRD 患者。使用 Pearson's r（总体和亚组）确定各州之间 AKI-D 发病率与肾脏恢复率之间的相关性。我们还计算了调整性别和年龄后的偏相关。
AKI-D 的发病率范围从佛蒙特州的 99.0/百万人口 (pmp) 到内华达州的 490.4 pmp。新发 ESRD 患者的肾脏恢复率范围从马萨诸塞州的 8.8 pmp 到佛罗里达州的 29.3 pmp。总体上（未调整 r=0.67；p=0.002）和在年龄、性别和种族亚组中，都发现了 AKI-D 发病率与新发 ESRD 患者肾脏恢复率之间的正相关。调整年龄（调整 r=0.62；p<0.001）和性别（调整 r=0.65；p<0.001）后，总体相关性仍然存在。
我们的研究结果表明，AKI-D 的发病率是新发 ESRD 患者肾脏恢复率的一个重要驱动因素。
