Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Nat Rev Nephrol. 2020 Apr;16(4):193-205. doi: 10.1038/s41581-019-0247-z. Epub 2020 Feb 12.
Acute kidney injury (AKI), once viewed predominantly as a self-limited and reversible condition, is now recognized as a growing problem associated with significant risks of adverse long-term health outcomes. Many cohort studies have established important relationships between AKI and subsequent risks of recurrent AKI, hospital re-admission, morbidity and mortality from cardiovascular disease and cancer, as well as the development of chronic kidney disease and end-stage kidney disease. In both high-income countries (HICs) and low-income or middle-income countries (LMICs), several challenges exist in providing high-quality, patient-centered care following AKI. Despite advances in our understanding about the long-term risks following AKI, large gaps in knowledge remain about effective interventions that can improve the outcomes of patients. Therapies for high blood pressure, glycaemic control (for patients with diabetes), renin-angiotensin inhibition and statins might be important in improving long-term cardiovascular and kidney outcomes after AKI. Novel strategies that incorporate risk stratification approaches, educational interventions and new models of ambulatory care following AKI have been described, and some of these are now being implemented and evaluated in clinical studies in HICs. Care for AKI in LMICs must overcome additional barriers due to limited resources for diagnosis and management.
急性肾损伤（AKI）曾经被认为是一种自限性和可逆转的疾病，但现在已被认识到是一个日益严重的问题，与不良长期健康结局的风险显著相关。许多队列研究已经确定了 AKI 与随后的复发性 AKI、医院再入院、心血管疾病和癌症发病率和死亡率以及慢性肾脏病和终末期肾脏病发展之间的重要关系。在高收入国家（HICs）和低收入或中等收入国家（LMICs），在 AKI 后提供高质量、以患者为中心的护理方面都存在一些挑战。尽管我们对 AKI 后长期风险的认识有所提高，但在可以改善患者结局的有效干预措施方面仍存在很大的知识差距。降压、血糖控制（糖尿病患者）、肾素-血管紧张素抑制和他汀类药物等疗法可能对改善 AKI 后的长期心血管和肾脏结局很重要。已经描述了一些新的策略，这些策略结合了风险分层方法、教育干预措施和 AKI 后的门诊护理新模式，其中一些正在 HICs 的临床研究中实施和评估。AKI 在 LMICs 的护理必须克服由于诊断和管理资源有限而产生的额外障碍。
