Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.
Centre for Integrated Critical Care, School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Nephrology (Carlton). 2021 Apr;26(4):319-327. doi: 10.1111/nep.13838. Epub 2020 Dec 10.
Acute kidney injury (AKI) during critical illness increases the risk of subsequent chronic kidney disease. Guidelines recommend inpatient nephrology assessment and review at 3 months.
To quantify the prevalence and predictors of inpatient and outpatient nephrology follow-up of AKI patients admitted to critical care areas within a tertiary hospital.
Retrospective study of all critically ill adults with AKI between January 1, 2012 and December 31, 2016 with a baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m and alive and independent of renal replacement therapy for 30 days after hospital discharge. We used logistic regression models to examine the primary outcome of nephrology review at 3 months. Secondary outcomes included inpatient nephrology review, renal recovery at discharge and the development of a major adverse kidney event (MAKE) at 1 year.
Of 702 critically ill patients with AKI (mean age 66 years, 64% male, baseline eGFR 78 mL/min/1.73 m ), 43 patients (6%) received nephrology follow-up at 3 months and 63 patients (9%) at 1 year. Nephrology follow-up occurred more frequently in patients with a higher baseline creatinine, a higher discharge creatinine and greater severity of AKI. Seventy patients (10%) underwent inpatient nephrology review. Overall, 414 (59%) had recovery of renal function by the time of discharge and 239 (34%) developed a MAKE at 12 months.
Inpatient and outpatient nephrology follow-up of AKI patients after admission to a critical care area was uncommon although one-third developed a MAKE. These findings provide the rationale for controlled studies of nephrology follow-up.
危重病患者发生急性肾损伤（AKI）会增加后续发生慢性肾脏病的风险。指南建议在 3 个月时进行住院肾脏病评估和复查。
定量评估在一家三级医院的重症监护病房住院的 AKI 患者接受住院和门诊肾脏病随访的情况及其预测因素。
对 2012 年 1 月 1 日至 2016 年 12 月 31 日期间所有患有 AKI 的危重症成年患者进行回顾性研究，这些患者的基线估算肾小球滤过率（eGFR）＞30 mL/min/1.73 m2，且在出院后 30 天内脱离肾脏替代治疗而存活并独立。我们使用逻辑回归模型来检验 3 个月时接受肾脏病复查这一主要结局。次要结局包括住院期间接受肾脏病复查、出院时肾功能恢复以及 1 年内发生主要不良肾脏事件（MAKE）。
在 702 例患有 AKI 的危重症患者中（平均年龄 66 岁，64%为男性，基线 eGFR 为 78 mL/min/1.73 m2），有 43 例（6%）在 3 个月时接受了肾脏病随访，有 63 例（9%）在 1 年时接受了随访。在基线肌酐较高、出院时肌酐较高和 AKI 严重程度较高的患者中，接受肾脏病随访的情况更为常见。70 例（10%）患者进行了住院期间的肾脏病复查。总体而言，有 414 例（59%）患者在出院时肾功能恢复，239 例（34%）患者在 12 个月时发生了 MAKE。
尽管有三分之一的患者发生了 MAKE，但 AKI 患者在入住重症监护病房后接受住院和门诊肾脏病随访的情况并不常见。这些发现为肾脏病随访的对照研究提供了依据。
