See Emily J, Ransley David G, Polkinghorne Kevan R, Toussaint Nigel D, Bailey Michael, Johnson David W, Robbins Ray, Bellomo Rinaldo
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2022 Jan;52(1):79-88. doi: 10.1111/imj.15138.
Survivors of acute kidney injury (AKI) are at increased risk of major adverse kidney events and international guidelines recommend individuals be evaluated 3 months following AKI.
We describe practice patterns and predictors of post-AKI care in an Australian tertiary hospital.
A retrospective analysis was undertaken of adults with AKI (defined by KDIGO criteria) admitted to a single centre between 2012 and 2016. The primary outcome was outpatient nephrology review at 3 months. Secondary outcomes included inpatient nephrology review, and outpatient serum creatinine and urinary protein measurements. Data were analysed using multivariable logistic and competing risk regression.
Only 117 of 2111 (6%) patients with AKI were reviewed by a nephrologist at 3 months. Reviewed patients were more likely to have a higher discharge serum creatinine (odds ratio (OR) 1.20 per 10 μmol/L increase; 95% confidence interval (CI) 1.16-1.25) or a history of peripheral vascular disease (OR 1.77; 95% CI 1.00-3.14). They were less likely to be older (OR 0.66 per decade; 95% CI 0.57-0.76) or to have a history of liver (OR 0.47; 95% CI 0.26-0.87) or ischaemic heart (OR 0.50; 95% CI 0.27-0.94) disease. AKI stage did not predict follow up. The median time from discharge to outpatient serum creatinine testing was 12 days (interquartile range 4-47) and proteinuria was measured in 538 (25%) patients.
A minority of admitted AKI patients receive recommended post-AKI care. Studies in other Australian institutions are required to confirm or refute these concerning findings.
急性肾损伤（AKI）幸存者发生重大不良肾脏事件的风险增加，国际指南建议在急性肾损伤后3个月对患者进行评估。
我们描述了澳大利亚一家三级医院急性肾损伤后护理的实践模式和预测因素。
对2012年至2016年间入住单一中心的符合KDIGO标准定义的急性肾损伤成年患者进行回顾性分析。主要结局是3个月时的门诊肾脏科复诊。次要结局包括住院肾脏科复诊以及门诊血清肌酐和尿蛋白测量。使用多变量逻辑回归和竞争风险回归分析数据。
2111例急性肾损伤患者中，只有117例（6%）在3个月时接受了肾脏科医生的复诊。接受复诊的患者更有可能出院时血清肌酐水平较高（每增加10μmol/L，比值比（OR）为1.20；95%置信区间（CI）为1.16 - 1.25）或有外周血管疾病史（OR 1.77；95% CI 1.00 - 3.14）。他们不太可能年龄较大（每增加十岁，OR为0.66；95% CI 0.57 - 0.76）或有肝脏疾病史（OR 0.47；95% CI 0.26 - 0.87）或缺血性心脏病史（OR 0.50；95% CI 0.27 - 0.94）。急性肾损伤分期并不能预测随访情况。出院至门诊血清肌酐检测的中位时间为12天（四分位间距4 - 47天），538例（25%）患者检测了蛋白尿。
少数急性肾损伤住院患者接受了推荐的急性肾损伤后护理。需要在澳大利亚其他机构开展研究以证实或反驳这些令人担忧的发现。
