Shah Silvi, Ng Jia H, Leonard Anthony C, Harrison Kathleen, Meganathan Karthikeyan, Christianson Annette L, Thakar Charuhas V
Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA.
Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA.
Clin Kidney J. 2024 Apr 8;17(5):sfae085. doi: 10.1093/ckj/sfae085. eCollection 2024 May.
Acute kidney injury (AKI) is a major contributor to end-stage kidney disease (ESKD). About one-third of patients with ESKD due to AKI recover kidney function. However, the inability to accurately predict recovery leads to improper triage of clinical monitoring and impacts the quality of care in ESKD.
Using data from the United States Renal Data System from 2005 to 2014 ( = 22 922), we developed a clinical score to predict kidney recovery within 90 days and within 12 months after dialysis initiation in patients with ESKD due to AKI. Multivariable logistic regressions were used to examine the effect of various covariates on the primary outcome of kidney recovery to develop the scoring system. The resulting logistic parameter estimates were transformed into integer point totals by doubling and rounding the estimates. Internal validation was performed.
Twenty-four percent and 34% of patients with ESKD due to AKI recovered kidney function within 90 days and 12 months, respectively. Factors contributing to points in the two scoring systems were similar but not identical, and included age, race/ethnicity, body mass index, congestive heart failure, cancer, amputation, functional status, hemoglobin and prior nephrology care. Three score categories of increasing recovery were formed: low score (0-6), medium score (7-9) and high score (10-12), which exhibited 90-day recovery rates of 12%, 26% and 57%. For the 12-month scores, the low, medium and high groups consisted of scores 0-5, 6-8 and 9-11, with 12-month recovery rates of 16%, 33% and 62%, respectively. The internal validation assessment showed no overfitting of the models.
A clinical score derived from information available at incident dialysis predicts renal recovery at 90 days and 12 months in patients with presumed ESKD due to AKI. The score can help triage appropriate monitoring to facilitate recovery and begin planning long-term dialysis care for others.
急性肾损伤（AKI）是终末期肾病（ESKD）的主要促成因素。约三分之一因AKI导致ESKD的患者肾功能可恢复。然而，无法准确预测恢复情况会导致临床监测的分诊不当，并影响ESKD的护理质量。
利用2005年至2014年美国肾脏数据系统的数据（n = 22922），我们开发了一种临床评分系统，以预测因AKI导致ESKD的患者在开始透析后90天内和12个月内的肾功能恢复情况。采用多变量逻辑回归分析各种协变量对肾功能恢复这一主要结局的影响，以建立评分系统。通过将逻辑参数估计值加倍并四舍五入，将得到的逻辑参数估计值转换为整数总分。进行了内部验证。
因AKI导致ESKD的患者中，分别有24%和34%在90天和12个月内肾功能恢复。两个评分系统中得分的影响因素相似但不完全相同，包括年龄、种族/民族、体重指数、充血性心力衰竭、癌症、截肢、功能状态、血红蛋白和既往肾病护理情况。形成了恢复程度递增的三个评分类别：低分（0 - 6分）、中分（7 - 9分）和高分（10 - 12分），其90天恢复率分别为12%、26%和57%。对于12个月的评分，低、中、高分组的得分分别为0 - 5分、6 - 8分和9 - 11分，12个月恢复率分别为16%、33%和62%。内部验证评估显示模型无过度拟合情况。
根据首次透析时可得信息得出的临床评分可预测因AKI导致的疑似ESKD患者在90天和12个月时的肾功能恢复情况。该评分有助于进行适当的分诊监测以促进恢复，并为其他患者开始规划长期透析护理。
