Montgomerie Christina, Spaak Jonas, Evans Marie, Jacobson Stefan H
Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Division of Cardiology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Kidney Dis (Basel). 2022 Nov 24;9(1):39-48. doi: 10.1159/000527299. eCollection 2023 Jan.
Complex integrated information on disease mechanisms and in-hospital outcomes in mild to moderate acute kidney injury (AKI) is scarce.
The Stockholm Prospective AKI Cohort Study (SAKIS) included all patients (≥18 years, = 1,519) with community-acquired AKI (KDIGO criteria) admitted to the nephrology ward at Danderyd University Hospital, Stockholm, Sweden, between 2009 and 2018. Detailed laboratory measures were registered. Odds ratio for hypo- and hyperkalemia, recovery of kidney function by 30% and 50%, and in-hospital mortality were assessed by logistic regression analysis.
Factors independently associated with the presence of hyperkalemia at admission were high age, high serum creatinine (sCr), and low C-reactive protein (CRP). Signs of malnutrition, inflammation, and acidosis were seen in 31% of patients. Kidney recovery, defined as a reduction of sCr by 30% in-hospital (63% of all patients), was associated with higher age, female sex, lower body mass index (BMI), higher hemoglobin, and higher CRP. Factors independently associated with mortality (4.4% of patients) were high age, high BMI, and low albumin.
This study provides a detailed description of community-acquired AKI and comprehensive analyses of integrated clinical and laboratory data associated with kidney recovery. Features related to anemia, albuminuria, malnutrition, inflammation, and acidosis associate with partial or moderate short-term recovery of kidney function, with disturbances in potassium homeostasis, and with in-hospital mortality. Future studies are warranted to analyze the long-term consequences of AKI in terms of risk of kidney failure, cardiovascular morbidity, and mortality.
关于轻度至中度急性肾损伤（AKI）的疾病机制和院内结局的复杂综合信息匮乏。
斯德哥尔摩前瞻性AKI队列研究（SAKIS）纳入了2009年至2018年期间在瑞典斯德哥尔摩丹德吕德大学医院肾病科住院的所有社区获得性AKI患者（≥18岁，n = 1519），采用KDIGO标准。记录了详细的实验室指标。通过逻辑回归分析评估低钾血症和高钾血症的比值比、肾功能恢复30%和50%的情况以及院内死亡率。
入院时与高钾血症存在独立相关的因素为高龄、高血清肌酐（sCr）和低C反应蛋白（CRP）。31%的患者存在营养不良、炎症和酸中毒迹象。肾功能恢复定义为住院期间sCr降低30%（占所有患者的63%），与高龄、女性、较低的体重指数（BMI）、较高的血红蛋白和较高的CRP相关。与死亡率（占患者的4.4%）独立相关的因素为高龄、高BMI和低白蛋白。
本研究详细描述了社区获得性AKI，并对与肾功能恢复相关的综合临床和实验室数据进行了全面分析。与贫血、蛋白尿、营养不良、炎症和酸中毒相关的特征与肾功能的部分或中度短期恢复、钾稳态紊乱以及院内死亡率相关。有必要开展未来研究以分析AKI在肾衰竭风险、心血管发病率和死亡率方面的长期后果。
