School of Medical Sciences, Universidade Estadual de Campinas, U.N.I.C.A.M.P., Campinas, SP, Brazil.
Laboratory of Atherosclerosis and Vascular Biology, Division of Cardiology, U.N.I.C.A.M.P., Campinas, SP, Brazil.
J Nephrol. 2024 Jun;37(5):1309-1315. doi: 10.1007/s40620-024-01953-4. Epub 2024 May 29.
The prevalence and risk factors for community-acquired acute kidney injury (CA-AKI) are unknown. This study aimed to explore the incidence of CA-AKI in a tertiary care center and to depict the main clinical characteristics related to this condition.
This was a prospective cohort study involving patients admitted to the emergency department (Hospital de Clínicas, UNICAMP, Campinas, Brazil) between January 2019 and September 2021. Adults (≥ 18 yrs) who presented to the emergency room with symptoms potentially associated with an increased risk of AKI were included. Individuals with a prior diagnosis of stage 5 chronic kidney disease or with a confirmed COVID-19 infection were excluded. A score based on clinical signs and symptoms was assigned to predict the risk of severe AKI.
Of the 261 patients enrolled, CA-AKI was diagnosed in 65 (25%). The CA-AKI group was older [57(± 14) vs. 51(± 18) years, p = 0.02] and had a lower baseline estimated glomerular filtration rate [103 (88-113) vs. 109 (97-121) mL/min/1.73 m; p = 0.01]. Logistic regression showed that scores ≥ 7 points [odds ratio (OR) 2.8 (1.281-6.133), 95% confidence interval (CI), p = 0.01], age [OR 1.02 (1.007-1.044), 95% CI, p = 0.008] and liver disease [OR 2.6 (1.063-6.379), 95% CI, p = 0.03] were independently related to CA-AKI.
The incidence of CA-AKI was not negligible among patients admitted to a tertiary care center; CA-AKI can be suspected on a clinical basis and confirmed by serum creatinine. Age, liver disease and higher scores in risk prediction tools were related to an increased incidence of CA-AKI.
社区获得性急性肾损伤（CA-AKI）的患病率和危险因素尚不清楚。本研究旨在探讨三级保健中心 CA-AKI 的发生率，并描述与该疾病相关的主要临床特征。
这是一项前瞻性队列研究，纳入了 2019 年 1 月至 2021 年 9 月期间在巴西坎皮纳斯 UNICAMP 医院急诊科就诊的患者。纳入标准为：年龄≥18 岁，因可能增加 AKI 风险的症状就诊急诊科。排除标准为：有 5 期慢性肾脏病病史或确诊 COVID-19 感染。根据临床症状和体征分配评分以预测严重 AKI 的风险。
在纳入的 261 例患者中，诊断出 65 例（25%）CA-AKI。CA-AKI 组年龄较大[57（±14）岁比 51（±18）岁，p=0.02]，基线估计肾小球滤过率较低[103（88-113）ml/min/1.73 m 比 109（97-121）ml/min/1.73 m，p=0.01]。Logistic 回归显示，评分≥7 分[比值比（OR）2.8（1.281-6.133），95%置信区间（CI），p=0.01]、年龄[OR 1.02（1.007-1.044），95%CI，p=0.008]和肝脏疾病[OR 2.6（1.063-6.379），95%CI，p=0.03]与 CA-AKI 独立相关。
三级保健中心住院患者的 CA-AKI 发生率不容忽视；CA-AKI 可以基于临床怀疑，并通过血清肌酐确认。年龄、肝脏疾病和风险预测工具中的高分与 CA-AKI 的发生率增加相关。
