Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria.
Jared Grantham Kidney Institute, Kansas University Medical Center, Kansas City, Kansas, USA.
Nephron. 2021;145(3):214-224. doi: 10.1159/000511405. Epub 2021 Mar 3.
Acute kidney injury (AKI) is known to be associated with increased mortality, and racial differences in hospital mortality exist in patients with AKI. However, it remains to be seen whether racial differences exist in post-hospitalization mortality among AKI patients.
We analyzed data of adult AKI patients admitted to the University of Virginia Medical Center between January 1, 2001, and December 31, 2015, to compare in-hospital and post-hospitalization mortality among hospitalized black and white patients with AKI. Multivariable logistic regression analysis was used to analyze the association between race and in-hospital mortality, and 90-day post-hospitalization mortality among AKI patients that were discharged. Kaplan-Meier survival curve was used to evaluate long-term survival between black and white patients.
Black patients had lower in-hospital mortality than white patients after adjusting for age, sex, estimated glomerular filtration rate, hospital length of stay, severity of AKI, comorbidities, and the need for dialysis and mechanical ventilation (odds ratio: 0.82; 95% confidence interval, 0.70-0.96, p = 0.0015). Similarly, at 90-day post-hospitalization, black patients had significantly lower adjusted odds of death than white patients (odds ratio: 0.64; 95% confidence interval, 0.46-0.93; p = 0.008). The median length of follow-up was 11.9 months (0.6-46.7 months). Kaplan-Meier survival curve showed that long-term survival was significantly better in black patients compared to white patients (median duration of survival; 39.7 vs. 24.8 months; p ≤ 0.001).
Black patients with AKI had lower in-hospital mortality, 90-day post-hospitalization mortality, and better long-term survival rates compared to white patients with AKI.
急性肾损伤（AKI）已知与死亡率增加有关，并且 AKI 患者的住院死亡率存在种族差异。然而，AKI 患者在住院后的死亡率是否存在种族差异仍有待观察。
我们分析了 2001 年 1 月 1 日至 2015 年 12 月 31 日期间在弗吉尼亚大学医疗中心住院的成年 AKI 患者的数据，以比较 AKI 住院的黑人和白人患者的住院死亡率和住院后死亡率。多变量逻辑回归分析用于分析 AKI 患者种族与住院死亡率以及出院后 90 天住院死亡率之间的关系。Kaplan-Meier 生存曲线用于评估黑人和白人患者之间的长期生存情况。
在调整年龄、性别、估算肾小球滤过率、住院时间、AKI 严重程度、合并症以及透析和机械通气的需要后，黑人患者的住院死亡率低于白人患者（比值比：0.82；95%置信区间，0.70-0.96，p = 0.0015）。同样，在住院后 90 天，黑人患者的死亡调整后比值比明显低于白人患者（比值比：0.64；95%置信区间，0.46-0.93；p = 0.008）。中位随访时间为 11.9 个月（0.6-46.7 个月）。Kaplan-Meier 生存曲线显示，与白人患者相比，黑人患者的长期生存率明显更高（中位生存时间；39.7 与 24.8 个月；p ≤ 0.001）。
与 AKI 白人患者相比，AKI 黑人患者的住院死亡率、住院后 90 天死亡率和长期生存率均较低。
