See Emily J, Toussaint Nigel D, Bailey Michael, Johnson David W, Polkinghorne Kevan R, Robbins Raymond, Bellomo Rinaldo
School of Medicine, University of Melbourne, Melbourne, Australia.
Department for Continuing Education, University of Oxford, Oxford, UK.
Clin Kidney J. 2019 Dec 20;14(2):556-563. doi: 10.1093/ckj/sfz169. eCollection 2021 Feb.
Acute kidney injury (AKI) survivors are at increased risk of major adverse kidney events (MAKEs), including chronic kidney disease (CKD), end-stage kidney disease (ESKD) and death. High-risk AKI patients may benefit from specialist follow-up, but factors associated with increased risk have not been reported.
We conducted a retrospective study of AKI patients admitted to a single centre between 2012 and 2016 who had a baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m and were alive and independent of renal replacement therapy (RRT) at 30 days following discharge. AKI was identified using International Classification of Diseases, Tenth Revision codes and staged according to the Kidney Disease: Improving Global Outcomes criteria. Patients were excluded if they were kidney transplant recipients or if AKI was attributed to intrinsic kidney disease. We performed Cox regression models to examine MAKEs in the first year, defined as the composite of CKD (sustained 25% drop in eGFR), ESKD (requirement for chronic RRT or sustained eGFR <15 mL/min/1.73 m) or death. We examined secondary outcomes (CKD, ESKD and death) using Cox and competing risk regression analyses.
We studied 2101 patients (mean ± SD age 69 ± 15 years, baseline eGFR 72 ± 23 mL/min/1.73 m). Of these, 767 patients (37%) developed at least one MAKE (429 patients developed CKD, 21 patients developed ESKD, 375 patients died). MAKEs occurred more frequently with older age [hazard ratio (HR) 1.16 per decade, 95% confidence interval (CI) 1.10-1.24], greater severity of AKI (Stage 2 HR 1.38, 95% CI 1.16-1.64; Stage 3 HR 1.62, 95% CI 1.31-2.01), higher serum creatinine at discharge (HR 1.04 per 10 µmol/L, 95% CI 1.03-1.06), chronic heart failure (HR 1.41, 95% CI 1.19-1.67), liver disease (HR 1.68, 95% CI 1.39-2.03) and malignancy (non-metastatic HR 1.44, 95% CI 1.14-1.82; metastatic HR 2.26, 95% CI 1.80-2.83). Traditional risk factors (e.g. diabetes and cardiovascular disease) had limited predictive value.
More than a third of AKI patients develop MAKEs within the first year. Clinical variables available at the time of discharge can help identify patients at increased risk of such events.
急性肾损伤（AKI）幸存者发生主要不良肾脏事件（MAKEs）的风险增加，包括慢性肾脏病（CKD）、终末期肾病（ESKD）和死亡。高危AKI患者可能从专科随访中获益，但与风险增加相关的因素尚未见报道。
我们对2012年至2016年期间入住单一中心的AKI患者进行了一项回顾性研究，这些患者基线估计肾小球滤过率（eGFR）>30 mL/min/1.73 m²，出院后30天存活且无需肾脏替代治疗（RRT）。使用国际疾病分类第十版编码识别AKI，并根据改善全球肾脏病预后组织（KDIGO）标准进行分期。如果患者是肾移植受者或AKI归因于原发性肾病，则将其排除。我们进行Cox回归模型以检查第一年的MAKEs，定义为CKD（eGFR持续下降25%）、ESKD（需要长期RRT或持续eGFR<15 mL/min/1.73 m²）或死亡的复合事件。我们使用Cox和竞争风险回归分析检查次要结局（CKD、ESKD和死亡）。
我们研究了2101例患者（平均±标准差年龄69±15岁，基线eGFR 72±23 mL/min/1.73 m²）。其中，767例患者（37%）发生了至少一项MAKEs（429例患者发生CKD，21例患者发生ESKD，375例患者死亡）。MAKEs在老年患者中更频繁发生[每十年风险比（HR）1.16，95%置信区间（CI）1.10-1.24]，AKI严重程度更高（2期HR 1.38，95%CI 1.16-1.64；3期HR 1.62，95%CI 1.31-2.01），出院时血清肌酐水平更高（每10 μmol/L HR 1.04，95%CI 1.03-1.06），慢性心力衰竭（HR 1.41，95%CI 1.19-1.67），肝病（HR 1.68，95%CI 1.39-2.03）和恶性肿瘤（非转移性HR 1.44，95%CI 1.14-1.82；转移性HR 2.26，95%CI 1.80-2.83）。传统危险因素（如糖尿病和心血管疾病）的预测价值有限。
超过三分之一的AKI患者在第一年内发生MAKEs。出院时可用的临床变量有助于识别发生此类事件风险增加的患者。
