Department of Nephrology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China.
Renal Division, Department of Medicine, Key Laboratory of Renal Disease, Ministry of Health of China, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China.
PLoS One. 2021 May 3;16(5):e0250934. doi: 10.1371/journal.pone.0250934. eCollection 2021.
International data suggest that people with diabetes mellitus (DM) are at increased risk for worse acute kidney injury (AKI) outcomes; however, the data in China are limited. Therefore, this study aimed to describe the association of DM with short-term prognosis, length of stay, and expenditure in patients with AKI.
This study was based on the 2013 nationwide survey in China. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) and expanded criteria of AKI, 7604 patients with AKI were identified, and 1404 and 6200 patients were with and without DM, respectively. Clinical characteristics, outcomes, length of stay, and costs of these patients were compared. Multivariate regression analyses were conducted to evaluate the association of DM with mortality, failed renal recovery, length of stay, and costs.
Patients with AKI and DM were older, had higher male preponderance (61.9%), presented with more comorbidities, and had higher serum creatinine levels compared with those without DM. An apparent increase in all-cause in-hospital mortality, length of stay, and costs was found in patients with DM. DM was not independently associated with failed renal recovery (adjusted OR (95%CI): 1.08 (0.94-1.25)) and in-hospital mortality (adjusted OR (95%): 1.16 (0.95-1.41)) in multivariate models. However, the diabetic status was positively associated with the length of stay (β = 0.06, p<0.05) and hospital expenditure (β = 0.10, p<0.01) in hospital after adjusting for possible confounders.
In hospitalized AKI patients, DM (vs. no DM) is independently associated with longer length of stay and greater costs, but is not associated with an increased risk for failed renal recovery and in-hospital mortality.
国际数据表明，糖尿病患者（DM）发生急性肾损伤（AKI）后结果更差的风险增加；然而，中国的数据有限。因此，本研究旨在描述 DM 与 AKI 患者短期预后、住院时间和支出的关系。
本研究基于 2013 年中国全国性调查。根据 2012 年肾脏病：改善全球预后（KDIGO）和 AKI 扩展标准，共确定了 7604 例 AKI 患者，其中 1404 例和 6200 例患者分别患有和不患有 DM。比较了这些患者的临床特征、结局、住院时间和费用。进行多变量回归分析以评估 DM 与死亡率、肾功能恢复失败、住院时间和费用的关系。
患有 AKI 和 DM 的患者年龄较大，男性比例较高（61.9%），合并症更多，血清肌酐水平更高。与无 DM 的患者相比，DM 患者的全因住院死亡率、住院时间和费用明显增加。DM 与肾功能恢复失败（调整后的 OR（95%CI）：1.08（0.94-1.25））和住院死亡率（调整后的 OR（95%）：1.16（0.95-1.41））在多变量模型中无独立相关性。然而，在调整了可能的混杂因素后，糖尿病状态与住院时间（β=0.06，p<0.05）和住院费用（β=0.10，p<0.01）呈正相关。
在住院 AKI 患者中，DM（与无 DM 相比）与住院时间延长和费用增加独立相关，但与肾功能恢复失败和住院死亡率增加无关。
