Division of Nephrology Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, Ohio.
Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio.
Clin J Am Soc Nephrol. 2020 Jul 1;15(7):995-1006. doi: 10.2215/CJN.11200919. Epub 2020 Jun 17.
AKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.
Mean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0-3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3-6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.
Kidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.
需要透析的急性肾损伤（AKI）是导致肾衰竭负担日益加重的原因之一，但对于 AKI 的恢复频率和模式及其对新透析患者结局的影响，我们知之甚少。
方法、设置、参与者和测量：利用美国肾脏数据系统，我们回顾性地评估了 2005 年 1 月 1 日至 2014 年 12 月 31 日期间 1045540 名新透析患者的队列。我们研究了 AKI 导致的肾衰竭与全因死亡率的关系，以及性别和种族与肾脏恢复之间的关系。
平均年龄为 63±15 岁，32598（3%）名新透析患者因 AKI 导致肾衰竭。与糖尿病导致的肾衰竭相比，AKI 导致的肾衰竭在透析开始后 0-3 个月（校正后的危险比，1.28；95%置信区间，1.24 至 1.32）和 3-6 个月（校正后的危险比，1.16；95%置信区间，1.11 至 1.20）时的死亡率更高。在 AKI 导致的肾衰竭患者中，11498 名（35%）最终恢复了肾功能，其中 95%的患者在 12 个月内恢复。女性的肾脏恢复可能性低于男性（校正后的危险比，0.86；95%置信区间，0.83 至 0.90）。与白人相比，黑人（校正后的危险比，0.68；95%置信区间，0.64 至 0.72）、亚洲人（校正后的危险比，0.82；95%置信区间，0.69 至 0.96）、西班牙裔（校正后的危险比，0.82；95%置信区间，0.76 至 0.89）和原住民（校正后的危险比，0.72；95%置信区间，0.54 至 0.95）的肾脏恢复可能性较低。
与糖尿病或其他原因导致的肾衰竭相比，AKI 导致的肾衰竭在最初 6 个月内的死亡率更高。在 12 个月内恢复是常见的，尽管女性的恢复率低于男性，黑人、亚洲人、西班牙裔和原住民患者的恢复率低于白人患者。
