van Vugt Lukas K, Wagenaar Eva, van Etten Ronald W
Amphia Ziekenhuis, afd. Interne Geneeskunde, Breda.
Contact: Lukas K. van Vugt (
Ned Tijdschr Geneeskd. 2021 Apr 8;165:D5528.
To analyse the incidence, risk factors and avoidability of acute kidney injury in adult patients admitted to a Dutch hospital.
Retrospective cohort study.
We assessed all consecutive admissions in our clinic during one week for the development of acute kidney injury and its cause. We compared medical information between patients with and without acute kidney injury to identify risk factors. We reviewed whether the current advice on kidney injury was followed to estimate the avoidability of acute kidney injury.
347 patients were older than 18 years and admitted for more than 1 day. Acute kidney injury occurred in 16.4% of patients. Almost half of the patients already developed acute kidney injury at home, before admission. Acute kidney damage was encountered in all medical specialties. Chronic kidney disease, diabetes mellitus and heart failure were significantly more common in patients with acute kidney injury. Patients with acute kidney injury used significantly more RAS-inhibitors and loop diuretics. The renal function completely restored in half of cases. Two thirds of acute kidney injury was probably avoidable if volume depletion had been optimized or medication with hemodynamic effects had been adjusted in time according to the guidelines.
Acute kidney injury is not only a common and underestimated problem in the daily practice of all doctors, but it is also probably avoidable. Awareness of the risk of acute kidney injury by doctors, pharmacists and patients can contribute to the reduction of acute kidney injury and its serious consequences.
分析荷兰一家医院收治的成年患者急性肾损伤的发生率、危险因素及可避免性。
回顾性队列研究。
我们评估了本诊所一周内所有连续入院患者急性肾损伤的发生情况及其病因。我们比较了发生急性肾损伤和未发生急性肾损伤患者的医疗信息，以确定危险因素。我们审查了是否遵循了当前关于肾损伤的建议，以评估急性肾损伤的可避免性。
347名患者年龄超过18岁，住院时间超过1天。16.4%的患者发生了急性肾损伤。近一半的患者在入院前在家中就已发生急性肾损伤。所有医学专科均有急性肾损伤病例。慢性肾病、糖尿病和心力衰竭在急性肾损伤患者中明显更为常见。急性肾损伤患者使用RAS抑制剂和襻利尿剂的比例明显更高。一半病例的肾功能完全恢复。如果根据指南及时优化容量不足或调整具有血流动力学效应的药物，三分之二的急性肾损伤可能是可避免的。
急性肾损伤不仅是所有医生日常临床实践中常见且被低估的问题，而且很可能是可避免的。医生、药剂师和患者对急性肾损伤风险的认识有助于减少急性肾损伤及其严重后果。
