Department of Internal Medicine, Nephrology, Dialysis and Transplantation Clinics, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Blood Purif. 2022;51(4):390-396. doi: 10.1159/000517707. Epub 2021 Jul 28.
Acute kidney injury (AKI) is a common complication among hospitalized patients, potentially affecting short- and long-term clinical outcomes. In this retrospective study, we evaluated renal outcomes in noncritically ill patients who required acute hemodialysis (HD) because of an AKI episode occurring during hospitalization.
Sixty-three hemodynamically stable patients with AKI undergoing acute intermittent HD were included. Kidney function was evaluated at baseline control (pre-AKI), at AKI diagnosis and during the follow-up. According to serum creatinine and the estimated glomerular filtration rate (eGFR), we defined three clinical conditions: renal recovery, different stages of acute kidney disease (AKD), and chronic kidney disease (CKD).
Among the 63 patients evaluated, 34 patients (54%) had a history of CKD. Six patients (10%) presented early full renal recovery. HD treatment was stopped in 38 patients (60%), while 25 patients (40%) required maintenance HD. Dialysis-independent patients presented lower comorbidity and higher baseline eGFR and delta creatinine, compared to dialysis-dependent patients. Baseline CKD, previous AKI episodes, and parenchymal causes of AKI were associated with a significant risk of dialysis dependence. At 1-month control, 15 patients (39%) presented AKD stage 0, 6 patients (16%) AKD stage 1, and 17 patients (44%) AKD stage 2-3. At 3-month control, 29 out of 38 patients recovering from AKI (76%) presented CKD. AKD stage was significantly correlated with the risk of CKD development, which, resulted higher in patients with lower baseline eGFR.
AKI might represent a risk factor for the development of chronic kidney damage, even in noncritically ill patients.
急性肾损伤（AKI）是住院患者的常见并发症，可能会影响短期和长期的临床结局。在这项回顾性研究中，我们评估了因住院期间发生的 AKI 而需要急性间歇性血液透析（HD）的非危重症患者的肾脏结局。
共纳入 63 例血流动力学稳定的 AKI 患者，行急性间歇性 HD 治疗。在基线对照（AKI 前）、AKI 诊断时和随访期间评估肾功能。根据血清肌酐和估算肾小球滤过率（eGFR），我们定义了三种临床情况：肾脏恢复、不同阶段的急性肾损伤（AKD）和慢性肾脏病（CKD）。
在 63 例评估患者中，34 例（54%）有 CKD 病史。6 例（10%）患者早期完全恢复肾功能。38 例（60%）患者停止 HD 治疗，25 例（40%）患者需要维持 HD。与依赖透析的患者相比，不依赖透析的患者合并症更少，基线 eGFR 和肌酐差值更高。基线 CKD、既往 AKI 发作和 AKI 的实质原因与依赖透析的显著风险相关。在 1 个月的随访中，15 例（39%）患者 AKD 分期 0，6 例（16%）患者 AKD 分期 1，17 例（44%）患者 AKD 分期 2-3。在 3 个月的随访中，38 例 AKI 恢复患者中有 29 例（76%）出现 CKD。AKD 分期与 CKD 发展风险显著相关，基线 eGFR 较低的患者发生 CKD 的风险更高。
AKI 可能是慢性肾脏损害的一个危险因素，即使在非危重症患者中也是如此。
