School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
Am J Nephrol. 2021;52(4):342-350. doi: 10.1159/000515231. Epub 2021 Apr 27.
Acute kidney diseases and disorders (AKD) encompass acute kidney injury (AKI) and subacute or persistent alterations in kidney function that occur after an initiating event. Unlike AKI, accurate estimates of the incidence and prognosis of AKD are not available and its clinical significance is uncertain.
We studied the epidemiology and long-term outcome of AKD (as defined by the KDIGO criteria), with or without AKI, in a retrospective cohort of adults hospitalized at a single centre for >24 h between 2012 and 2016 who had a baseline eGFR ≥60 mL/min/1.73 m2 and were alive at 30 days. In patients for whom follow-up data were available, the risks of major adverse kidney events (MAKEs), CKD, kidney failure, and death were examined by Cox and competing risk regression analyses.
Among 62,977 patients, 906 (1%) had AKD with AKI and 485 (1%) had AKD without AKI. Follow-up data were available for 36,118 patients. In this cohort, compared to no kidney disease, AKD with AKI was associated with a higher risk of MAKEs (40.25 per 100 person-years; hazard ratio [HR] 2.51, 95% confidence interval [CI] 2.16-2.91), CKD (27.84 per 100 person-years); subhazard ratio [SHR] 3.18, 95% CI 2.60-3.89), kidney failure (0.56 per 100 person-years; SHR 24.84, 95% CI 5.93-104.03), and death (14.86 per 100 person-years; HR 1.52, 95% CI 1.20-1.92). Patients who had AKD without AKI also had a higher risk of MAKEs (36.21 per 100 person-years; HR 2.26, 95% CI 1.89-2.70), CKD (22.94 per 100 person-years; SHR 2.69, 95% CI 2.11-3.43), kidney failure (0.28 per 100 person-years; SHR 12.63, 95% CI 1.48-107.64), and death (14.86 per 100 person-years; HR 1.57, 95% CI 1.19-2.07). MAKEs after AKD were driven by CKD, especially in the first 3 months.
These findings establish the burden and poor prognosis of AKD and support prioritisation of clinical initiatives and research strategies to mitigate such risk.
急性肾损伤（AKI）和肾脏功能的亚急性或持续性改变，这些改变发生在起始事件之后。与 AKI 不同，AKD 的发病率和预后的准确估计并不可用，其临床意义也不确定。
我们研究了 2012 年至 2016 年间在一家单一中心住院超过 24 小时的成年人的 AKD（根据 KDIGO 标准定义）的流行病学和长期结局，这些患者基线 eGFR≥60 mL/min/1.73 m2，且在 30 天时存活。对于有随访数据的患者，通过 Cox 和竞争风险回归分析检查主要不良肾脏事件（MAKEs）、慢性肾脏病（CKD）、肾衰竭和死亡的风险。
在 62977 名患者中，906 名（1%）患有伴有 AKI 的 AKD，485 名（1%）患有不伴有 AKI 的 AKD。有 36118 名患者有随访数据。在这个队列中，与没有肾脏疾病相比，伴有 AKI 的 AKD 与更高的 MAKEs 风险相关（40.25 人/100 人年；风险比[HR]2.51，95%置信区间[CI]2.16-2.91）、CKD（27.84 人/100 人年；亚危险比[SHR]3.18，95%CI 2.60-3.89）、肾衰竭（0.56 人/100 人年；SHR 24.84，95%CI 5.93-104.03）和死亡（14.86 人/100 人年；HR 1.52，95%CI 1.20-1.92）。没有 AKI 的 AKD 患者也有更高的 MAKEs 风险（36.21 人/100 人年；HR 2.26，95%CI 1.89-2.70）、CKD（22.94 人/100 人年；SHR 2.69，95%CI 2.11-3.43）、肾衰竭（0.28 人/100 人年；SHR 12.63，95%CI 1.48-107.64）和死亡（14.86 人/100 人年；HR 1.57，95%CI 1.19-2.07）。AKD 后的 MAKEs 是由 CKD 驱动的，尤其是在最初的 3 个月内。
这些发现确立了 AKD 的负担和不良预后，并支持优先考虑临床举措和研究策略，以减轻这种风险。
