Glendell Rebecca M, Puxty Kathryn A, Shaw Martin, Sim Malcolm Ab, Traynor Jamie P, Mark Patrick B, Andonovic Mark
Undergraduate Medical School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK.
J Intensive Care Soc. 2024 Dec 26;26(1):29-37. doi: 10.1177/17511437241308673. eCollection 2025 Feb.
Acute kidney injury (AKI) within the intensive care unit (ICU) is common but evidence is limited on longer-term renal outcomes. We aimed to model the trend of kidney function in ICU survivors using estimated glomerular filtration rate (eGFR), comparing those with and without AKI, and investigate potential risk factors associated with eGFR decline.
This observational cohort study included all patients aged 16 or older admitted to two general adult ICUs in Scotland between 1st July 2015 and 30th June 2018 who survived to 30 days following hospital discharge. Baseline serum creatinine and subsequent values were used to identify patients with AKI and calculate eGFR following hospital discharge. Mixed effects modelling was used to control for repeated measures and to allow inclusion of several exploratory variables.
3649 patients were included, with 1252 (34%) experiencing in-ICU AKI. Patients were followed up for up to 2000 days with a median 21 eGFR measurements. eGFR declined at a rate of -1.9 ml/min/1.73m/year (value < 0.001) in the overall ICU survivor cohort. Patients with AKI experienced an accelerated rate of post-ICU eGFR decline of -2.0 ml/min/1.73m/year compared to a rate of -1.83 ml/min/1.73m/year in patients who did not experience AKI (value 0.007). Pre-existing diabetes or liver disease and in-ICU vasopressor support were associated with accelerated eGFR decline regardless of AKI experience.
ICU survivors experienced a decline in kidney function beyond that which would be expected regardless of in-ICU AKI. Long-term follow-up is warranted in ICU survivors to monitor kidney function and reduce morbidity and mortality.
重症监护病房（ICU）内的急性肾损伤（AKI）很常见，但关于长期肾脏转归的证据有限。我们旨在使用估算肾小球滤过率（eGFR）对ICU幸存者的肾功能趋势进行建模，比较发生和未发生AKI的患者，并调查与eGFR下降相关的潜在危险因素。
这项观察性队列研究纳入了2015年7月1日至2018年6月30日期间入住苏格兰两家成人综合ICU且出院后存活30天的所有16岁及以上患者。出院后，使用基线血清肌酐及后续数值来识别AKI患者并计算eGFR。采用混合效应模型来控制重复测量，并纳入多个探索性变量。
共纳入3649例患者，其中1252例（34%）在ICU期间发生AKI。对患者进行了长达2000天的随访，eGFR测量中位数为21次。在整个ICU幸存者队列中，eGFR以-1.9 ml/min/1.73m²/年的速度下降（P值<0.001）。发生AKI的患者在ICU后的eGFR下降速度加快，为-2.0 ml/min/1.73m²/年，而未发生AKI的患者下降速度为-1.83 ml/min/1.73m²/年（P值=0.007）。无论是否发生AKI，既往糖尿病或肝病以及ICU内使用血管升压药支持均与eGFR下降加速有关。
无论在ICU期间是否发生AKI，ICU幸存者的肾功能下降幅度均超过预期。对ICU幸存者进行长期随访以监测肾功能并降低发病率和死亡率是必要的。
