Centro de Ciências da Saúde - FACIME/UESPI - Coordenação de Medicina, Universidade Estadual do Piauí, Rua Olavo Bilac, 2335, Centro, Teresina, PI, CEP 64001-280, Brazil.
FACID/Wyden - Coordenação Medicina, Teresina, Brazil.
BMC Nephrol. 2020 Mar 11;21(1):94. doi: 10.1186/s12882-020-01751-7.
In low-middle-income countries (LMICs), data regarding acute kidney injury (AKI) are scarce. AKI patients experience delayed diagnosis. This study aimed to evaluate whether delayed nephrologist consultation (NC) affected outcomes of AKI patients and compare Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO).
An observational, retrospective study was conducted in a tertiary public hospital in an LMIC.
Overall, 103 AKI patients were analysed. In-hospital mortality was 61.16%, and dialysis was required in 38.83%. NC took place after 48 h in 68.93% of the patients. Mean time for NC was 5.22 ± 4.30 days. At NC, serum creatinine was 4.48 (±3.40) mg/dL and blood urea nitrogen was 68.21 (± 35.02) mg/dL. The AKIN and KDIGO stage stratifications were identical; KDIGO stage 3 was seen in 58.25% of the patients. The group with NC > 4 days had a mortality rate of 74.46% and the group with NC ≤ 4 days had a mortality rate of 50% (p = 0.011). Multivariate analysis showed that haemodialysis was independently associated with mortality. NC > 4 days was associated with death [odds ratio 2.66 (95% confidence interval, 1.36-4.35), p = 0.001]. Logistic regression showed an OR of 1.20 (95% CI, 1.05-1.37) (p = 0.008) for each day of delayed NC.
Delayed NC was associated with mortality even after adjustments, as was haemodialysis, though marginally. In AKI patients with NC > 4 days, there was a high prevalence of KDIGO stage 3, and AKIN and KDIGO criteria were identical.
在中低收入国家（LMICs），关于急性肾损伤（AKI）的数据很少。AKI 患者的诊断存在延迟。本研究旨在评估延迟肾科医生会诊（NC）是否会影响 AKI 患者的预后，并比较急性肾损伤网络（AKIN）和肾脏病：改善全球预后（KDIGO）。
在一个 LMIC 的三级公立医院进行了一项观察性、回顾性研究。
总共分析了 103 例 AKI 患者。住院死亡率为 61.16%，需要透析的患者为 38.83%。68.93%的患者在 48 小时后进行 NC。NC 的平均时间为 5.22±4.30 天。NC 时血清肌酐为 4.48（±3.40）mg/dL，血尿素氮为 68.21（±35.02）mg/dL。AKIN 和 KDIGO 分期分层相同；58.25%的患者处于 KDIGO 分期 3 期。NC>4 天的患者死亡率为 74.46%，NC≤4 天的患者死亡率为 50%（p=0.011）。多变量分析显示血液透析与死亡率独立相关。NC>4 天与死亡相关[优势比 2.66（95%置信区间，1.36-4.35），p=0.001]。Logistic 回归显示，NC 每延迟一天，死亡的 OR 为 1.20（95%CI，1.05-1.37）（p=0.008）。
即使经过调整，NC 延迟仍与死亡率相关，与血液透析相关，尽管只是略有相关。在 NC>4 天的 AKI 患者中，KDIGO 分期 3 的患病率较高，AKIN 和 KDIGO 标准相同。
