Jeong Rachel, Haines Ryan, Ostermann Marlies
Division of Nephrology, Department of Medicine.
Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
Curr Opin Crit Care. 2024 Oct 1;30(5):502-509. doi: 10.1097/MCC.0000000000001183. Epub 2024 Jun 19.
Acute kidney injury (AKI) in critical illness is common, and survivors are faced with a host of adverse outcomes. In this article, we review the current landscape of outcomes and care in survivors of AKI and critical illness.
Follow-up care of survivors of AKI and critical illness is prudent to monitor for and mitigate the risk of adverse outcomes. Observational data have suggested improvement in outcomes with nephrology-based follow-up care, and recent interventional studies demonstrate similar findings. However, current post-AKI care is suboptimal with various challenges, such as breakdowns in the transition of care during hospital episodes and into the community, barriers for patients in follow-up, and lack of identification of high-risk patients for nephrology-based follow-up. Tools predictive of renal nonrecovery and long-term outcomes may help to identify high-risk patients who may benefit the most from nephrology-based care post-AKI.
Follow-up care of survivors of AKI and critical illness may improve outcomes and there is a need to prioritize transitions of care into the community. Further research is needed to elucidate the best ways to risk-stratify and manage post-AKI survivors to improve outcomes.
危重症患者中的急性肾损伤（AKI）很常见，幸存者面临一系列不良后果。在本文中，我们综述了AKI和危重症幸存者目前的预后及护理情况。
对AKI和危重症幸存者进行随访护理，对于监测和降低不良后果风险是审慎之举。观察性数据表明，基于肾脏病学的随访护理可改善预后，近期的干预性研究也证实了类似结果。然而，目前的急性肾损伤后护理并不理想，存在各种挑战，如住院期间及转入社区时护理过渡环节出现问题、患者随访存在障碍以及缺乏对基于肾脏病学随访的高危患者的识别。预测肾脏无法恢复及长期预后的工具可能有助于识别出从急性肾损伤后基于肾脏病学的护理中获益最大的高危患者。
对AKI和危重症幸存者进行随访护理可能改善预后，并且有必要优先考虑向社区的护理过渡。需要进一步研究以阐明对急性肾损伤后幸存者进行风险分层和管理的最佳方法，从而改善预后。
