重症监护病房急性肾损伤后急性肾损伤的临床轨迹和影响：一项为期 5 年的单中心队列研究。

Clinical trajectories and impact of acute kidney disease after acute kidney injury in the intensive care unit: a 5-year single-centre cohort study.

机构信息

Service de Médecine Intensive Réanimation, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.

AURAD Aquitaine, 2, allée des demoiselles, Gradignan, France.

出版信息

Nephrol Dial Transplant. 2023 Jan 23;38(1):167-176. doi: 10.1093/ndt/gfac054.

DOI:10.1093/ndt/gfac054

PMID:35238922

Abstract

BACKGROUND

Patients suffering from acute kidney injury(AKI) in the intensive care unit (ICU) can have various renal trajectories and outcomes. Aims were to assess the various clinical trajectories after AKI in the ICU and to determine risk factors for developing chronic kidney disease (CKD).

METHODS

We conducted a prospective 5-year follow-up study in a medical ICU at Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion or both and developed an AKI from September 2013 to May 2015 were included. In the Cox analysis, the violation of the proportional hazard assumption for AKD was handled using appropriate interaction terms with time, resulting in a time-dependent hazard ratio (HR).

RESULTS

A total of 232 patients were enrolled, with an age of 62 ± 16 years and a median follow-up of 52 days (interquartile range 6-1553). On day 7, 109/232 (47%) patients progressed to acute kidney disease (AKD) and 66/232 (28%) recovered. A linear trajectory (AKI, AKD to CKD) was followed by 44/63 (70%) of the CKD patients. The cumulative incidence of CKD was 30% [95% confidence interval (CI) 24-36] at the 5-year follow-up. In a multivariable Cox model, in the 6 months following AKI, the HR for CKD was higher in AKD patients [HR 29.2 (95% CI 8.5-100.7); P < 0.0001). After 6 months, the HR for CKD was 2.2 (95% CI 0.6-7.9; P = 0.21; n = 172 patients).

CONCLUSION

There were several clinical trajectories of kidney disease after ICU-acquired AKI. CKD risk was higher in AKD patients only in the first 6 months. Lack of renal recovery rather than AKD per se was associated with the risk of CKD.

摘要

背景

重症监护病房（ICU）中患有急性肾损伤（AKI）的患者可能有多种肾脏轨迹和结局。目的是评估 ICU 中 AKI 后的各种临床轨迹，并确定发展为慢性肾脏病（CKD）的危险因素。

方法

我们在波尔多大学医院（法国）的医疗 ICU 进行了一项为期 5 年的前瞻性随访研究。纳入了 2013 年 9 月至 2015 年 5 月期间接受有创机械通气、儿茶酚胺输注或两者联合治疗并发生 AKI 的患者。在 Cox 分析中，使用与时间的适当交互项处理 AKD 违反比例风险假设，从而得到时间依赖性风险比（HR）。

结果

共纳入 232 例患者，年龄 62±16 岁，中位随访时间为 52 天（四分位距 6-1553）。第 7 天，232 例患者中有 109 例（47%）进展为急性肾疾病（AKD），66 例（28%）恢复。44/63（70%）的 CKD 患者遵循线性轨迹（AKI、AKD 至 CKD）。在 5 年随访时，CKD 的累积发生率为 30%[95%置信区间（CI）24-36]。在多变量 Cox 模型中，在 AKI 后的 6 个月内，AKD 患者的 CKD 风险更高[HR 29.2（95%CI 8.5-100.7）；P<0.0001]。6 个月后，CKD 的 HR 为 2.2（95%CI 0.6-7.9；P=0.21；n=172 例）。