Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Chang Gung University College of Medicine, Taoyuan, Taiwan.
JAMA Netw Open. 2024 Mar 4;7(3):e240351. doi: 10.1001/jamanetworkopen.2024.0351.
The interplay among baseline kidney function, severity of acute kidney disease (AKD), and post-AKD kidney function has significant associations with patient outcomes. However, a comprehensive understanding of how these factors are collectively associated with mortality, major adverse cardiac events (MACEs), and end-stage kidney disease (ESKD) in patients with dialysis-requiring acute kidney injury (AKI-D) is yet to be fully explored.
To investigate the associations of baseline kidney function, AKD severity, and post-AKD kidney function with mortality, MACEs, and ESKD in patients with AKI-D.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based cohort study of patients with AKI-D was conducted between January 1, 2015, and December 31, 2018, using data from various health care settings included in the Taiwan nationwide population-based cohort database. Data analysis was conducted from April 28, 2022, to June 30, 2023.
Exposure to severe AKI and baseline and post-AKD kidney function.
The primary outcomes were all-cause mortality and incident MACEs, and secondary outcomes were risks of permanent dialysis and readmission.
A total of 6703 of 22 232 patients (mean [SD] age, 68.0 [14.7] years; 3846 [57.4%] male) with AKI-D with post-AKD kidney function follow-up and AKD stage data were enrolled. During a mean (SD) 1.2 (0.9) years of follow-up, the all-cause mortality rate was 28.3% (n = 1899), while the incidence rates of MACEs and ESKD were 11.1% (n = 746) and 16.7% (n = 1119), respectively. After adjusting for known covariates, both post-AKD kidney function and baseline kidney function, but not AKD severity, were independently associated with all-cause mortality, MACEs, ESKD, and readmission. Moreover, worse post-AKD kidney function correlated with progressive and significant increases in the risk of adverse outcomes.
In this cohort study of patients with AKI-D, more than one-quarter of patients died after 1.2 years of follow-up. Baseline and post-AKD kidney functions serve as important factors associated with the long-term prognosis of patients with AKI-D. Therefore, concerted efforts to understand the transition from post-AKD to chronic kidney disease are crucial.
基线肾功能、急性肾损伤（AKD）严重程度和 AKD 后肾功能之间的相互作用与患者预后有显著关联。然而，对于透析依赖型急性肾损伤（AKI-D）患者的死亡率、主要不良心脏事件（MACEs）和终末期肾病（ESKD），这些因素如何共同起作用仍有待深入研究。
探讨基线肾功能、AKD 严重程度和 AKD 后肾功能与 AKI-D 患者死亡率、MACEs 和 ESKD 的关系。
设计、设置和参与者：这是一项全国性的基于人群队列研究，纳入了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间来自台湾全国基于人群队列数据库中各种医疗保健机构的数据。数据分析于 2022 年 4 月 28 日至 2023 年 6 月 30 日进行。
严重 AKI 和基线及 AKD 后肾功能。
主要结局是全因死亡率和新发 MACEs，次要结局是永久性透析和再入院的风险。
共纳入了 22232 例 AKI-D 患者中的 6703 例（平均[标准差]年龄 68.0[14.7]岁；3846[57.4%]为男性），这些患者有 AKD 后肾功能随访和 AKD 分期数据。在平均（标准差）1.2（0.9）年的随访期间，全因死亡率为 28.3%（n=1899），MACEs 和 ESKD 的发生率分别为 11.1%（n=746）和 16.7%（n=1119）。在调整了已知混杂因素后，AKD 后肾功能和基线肾功能均与全因死亡率、MACEs、ESKD 和再入院独立相关，而 AKD 严重程度则无此关联。此外，AKD 后肾功能恶化与不良结局风险的进行性显著增加相关。
在这项 AKI-D 患者的队列研究中，超过四分之一的患者在 1.2 年的随访后死亡。基线和 AKD 后肾功能是与 AKI-D 患者长期预后相关的重要因素。因此，共同努力了解 AKD 后向慢性肾脏病的转变至关重要。
