Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan.
Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu City Shizuoka, Japan.
BMC Nephrol. 2024 Jul 12;25(1):222. doi: 10.1186/s12882-024-03666-z.
Acute kidney injury (AKI) incidence is extremely high worldwide, and patients who develop AKI are at increased risk of developing chronic kidney disease (CKD), CKD progression, and end-stage kidney disease (ESKD). However, there is no established treatment strategy for AKI. Based on the idea that exercise has a stabilizing effect on hemodynamics, we hypothesized that rehabilitation would have beneficial renal outcomes in patients with AKI associated with cardiovascular disease. Therefore, the purpose of this study was to determine whether rehabilitation can stabilize hemodynamics and positively impact renal outcomes in patients with AKI associated with cardiovascular disease.
In total, 107 patients with AKI associated with cardiovascular disease were enrolled in this single-center retrospective study and were either assigned to the exposure group (n = 36), which received rehabilitation at least once a week for at least 8 consecutive weeks, or to the control group (n = 71). Estimated glomerular filtration rate was assessed at baseline before admission, at the lowest value during hospitalization, and at 3, 12, and 24 months after enrolment. Trends over time (group × time) between the two groups were compared using generalized estimating equations. Moreover, congestive status was assessed by amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and the effect of rehabilitation on congestion improvement was investigated using logistical regression analysis.
The time course of renal function after AKI, from baseline to each of the three timepoints suggested significant differences between the two groups (p < 0.01). However, there was no significant difference between the two groups at any time point in terms of percentage of patients who experienced a 40% estimated glomerular filtration rate reduction from that at baseline. The proportion of patients with improved congestion was significantly higher in the exposure group compared with that in the control group (p = 0.018). Logistic regression analysis showed that rehabilitation was significantly associated with improved congestion (p = 0.021, OR: 0.260, 95%CI: 0.083-0.815).
Our results suggest that rehabilitation in patients with AKI associated with cardiovascular disease correlates with an improvement in congestion and may have a positive effect on the course of renal function.
急性肾损伤（AKI）的发病率在全球范围内极高，发生 AKI 的患者发生慢性肾脏病（CKD）、CKD 进展和终末期肾病（ESKD）的风险增加。然而，目前尚无针对 AKI 的既定治疗策略。基于运动对血液动力学具有稳定作用的理念，我们假设康复治疗对伴有心血管疾病的 AKI 患者的肾脏结局有益。因此，本研究的目的是确定康复治疗是否可以稳定伴有心血管疾病的 AKI 患者的血液动力学并对其肾脏结局产生积极影响。
这项单中心回顾性研究共纳入 107 例伴有心血管疾病的 AKI 患者，将其分为暴露组（n=36）和对照组（n=71）。暴露组每周至少接受一次康复治疗，至少持续 8 周。在入院前、住院期间最低值以及入组后 3、12 和 24 个月时评估估算肾小球滤过率。使用广义估计方程比较两组之间的时间趋势（组×时间）。此外，通过氨基末端 B 型利钠肽前体（NT-proBNP）评估充血状态，并使用逻辑回归分析研究康复治疗对充血改善的影响。
从基线到三个时间点的 AKI 后肾功能时间过程表明，两组之间存在显著差异（p<0.01）。然而，在任何时间点，两组患者的估算肾小球滤过率从基线下降 40%的比例均无显著差异。暴露组中充血改善的患者比例明显高于对照组（p=0.018）。逻辑回归分析显示，康复治疗与充血改善显著相关（p=0.021，OR：0.260，95%CI：0.083-0.815）。
我们的研究结果表明，伴有心血管疾病的 AKI 患者的康复治疗与充血改善相关，并且可能对肾功能的病程产生积极影响。
