Abdala Pedro M, Swanson Elizabeth A, Hutchens Michael P
Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.
Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, USA.
Perioper Med (Lond). 2021 Jun 29;10(1):24. doi: 10.1186/s13741-021-00192-6.
Recent research shows AKI increases the risk of incident CKD. We hypothesized that perioperative AKI may confer increased risk of subsequent CKD compared to nonperioperative AKI.
A MEDLINE search was performed for "AKI, CKD, chronic renal insufficiency, surgery, and perioperative" and related terms yielded 5209 articles. One thousand sixty-five relevant studies were reviewed. One thousand six were excluded because they were review, animal, or pediatric studies. Fifty-nine studies underwent full manuscript review by two independent evaluators. Seventeen met all inclusion criteria and underwent analysis. Two-by-two tables were constructed from AKI +/- and CKD +/- data. The R package metafor was employed to determine odds ratio (OR), and a random-effects model was used to calculate weighted ORs. Leave-1-out, funnel analysis, and structured analysis were used to estimate effects of study heterogeneity and bias.
Nonperioperative studies included studies of oncology, percutaneous coronary intervention, and myocardial infarction patients. Perioperative studies comprised patients from cardiac surgery, vascular surgery, and burns. There was significant heterogeneity, but risk of bias was overall assessed as low. The OR for AKI versus non-AKI patients developing CKD in all studies was 4.31 (95% CI 3.01-6.17; p < 0.01). Nonperioperative subjects demonstrated OR 3.32 for developing CKD compared to non-AKI patients (95% CI 2.06-5.34; p < 0.01) while perioperative patients demonstrated OR 5.20 (95% CI 3.12-8.66; p < 0.01) for the same event.
We conclude that studies conducted in perioperative and nonperioperative patient populations suggest similar risk of development of CKD after AKI.
近期研究表明急性肾损伤（AKI）会增加慢性肾脏病（CKD）发病风险。我们推测，与非围手术期急性肾损伤相比，围手术期急性肾损伤可能会增加后续发生慢性肾脏病的风险。
在MEDLINE数据库中检索“急性肾损伤、慢性肾脏病、慢性肾功能不全、手术及围手术期”及相关术语，共检索到5209篇文章。对1065项相关研究进行了综述。其中1006项研究因属于综述、动物或儿科研究而被排除。59项研究由两名独立评估人员进行全文审查。17项研究符合所有纳入标准并进行分析。根据急性肾损伤阳性/阴性和慢性肾脏病阳性/阴性数据构建四格表。使用R软件包metafor确定比值比（OR），并采用随机效应模型计算加权OR。采用留一法、漏斗图分析和结构化分析来评估研究异质性和偏倚的影响。
非围手术期研究包括肿瘤学、经皮冠状动脉介入治疗和心肌梗死患者的研究。围手术期研究包括心脏手术、血管手术和烧伤患者。存在显著异质性，但总体偏倚风险评估为低。在所有研究中，急性肾损伤患者与非急性肾损伤患者发生慢性肾脏病的OR为4.31（95%CI 3.01 - 6.17；p < 0.01）。与非急性肾损伤患者相比，非围手术期受试者发生慢性肾脏病的OR为3.32（95%CI 2.06 - 5.34；p < 0.01），而围手术期患者发生相同事件的OR为5.20（95%CI 3.12 - 8.66；p < 0.01）。
我们得出结论，在围手术期和非围手术期患者群体中进行的研究表明，急性肾损伤后发生慢性肾脏病的风险相似。
