School of Nursing-the University of Jordan, Amman 11942 Jordan.
Sheikh Khalifa Medical City, Ajman 2758 United Arab Emirates.
Heart Lung. 2020 Sep-Oct;49(5):626-629. doi: 10.1016/j.hrtlng.2020.04.013. Epub 2020 Apr 28.
The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common.
To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI.
A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m on admission.
Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02-1.05;(P<0.001) and AKI (1.68; 95% CI 1.12-2.5;P<0.01) in patients with pre-existing CKD. Only APACHI-II (1.03; 95% CI 1.0-1.1; p < 0.001) was predictive of death in patients without pre-existing CKD.
Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality.
患有慢性肾脏病（CKD）和急性肾损伤（AKI）的危重症患者的健康结局尚不清楚。然而，CKD 合并 AKI 在危重症患者中很常见。
比较患有和不患有 CKD 且发生 AKI 的危重症患者在入院后一个月内的死亡风险。
使用病历回顾进行了一项多中心回顾性比较研究。研究参与者包括 826 名在 2012 年 1 月至 2017 年 12 月期间在重症监护病房接受至少 6 小时机械通气的成年患者。通过血清肌酐评估肾功能。使用 RIFLE 标准定义 AKI 的严重程度和分期：风险、损伤、衰竭、丧失和终末期肾病。入院时 eGFR>60ml/mg/1.73m 定义为慢性肾脏病。
55%的患者入院时存在 CKD，7%的患者在入院后 7 天内发生 AKI。这些患者的总死亡率为 87.3%。CKD 患者的死亡率最高（70.1%），其次是无 CKD 但发生 AKI 的患者（20.7%）和有 CKD 但发生 AKI 的患者（7.1%）。与死亡率相关的风险因素是 APACHE II 评分（1.03；95%CI 1.02-1.05；P<0.001）和 CKD 患者的 AKI（1.68；95%CI 1.12-2.5；P<0.01）。仅 APACHI-II（1.03；95%CI 1.0-1.1；p < 0.001）是无 CKD 患者死亡的预测因素。
与无 CKD 的患者相比，患有合并症 CKD 的危重症患者的死亡风险更高，无论他们是否发生 AKI。早期识别 CKD 并认识到这些患者的死亡风险可能会导致更早的干预，从而降低死亡率。
