Herath Nalaka, De Silva Shamila, Liyanage Prasitha, Kumara Sameera, Devi Suganthika, Abeysekara Vajira, Mallawarachi Ruvini, Perera Suharshi, Karunathilaka Iresha, Samarasinghe Sameera, Weerakoon Kosala
Department of Nephrology, Colombo North Teaching Hospital, Ragama, Sri Lanka.
Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Int J Nephrol. 2024 Dec 24;2024:4484755. doi: 10.1155/ijne/4484755. eCollection 2024.
The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (=0.017). More severe AKI was associated with type 2 diabetes (=0.0042), hypertension ( < 0.0001) and multiple comorbidities (=0.0014). Persons with no comorbidities had less severe AKI (=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and =0.047). AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.
急性肾损伤（AKI）的预后取决于病因、患者因素及所接受的治疗。我们在斯里兰卡一家三级转诊中心研究了AKI患者的病因、并发症及90天预后情况。对年龄在18岁及以上转诊至肾脏病服务科室的AKI患者进行回顾性分析。采用KDIGO分类法评估AKI严重程度。信息收集自医院和诊所记录。在464例研究患者中，262例（56.5%）为男性。研究样本的平均年龄为57.04（标准差16.85）岁。大多数患者（212例，占45.69%）出院时肾功能正常，173例（37.28%）出院时肾功能受损，79例（17.03%）在住院期间死亡。3个月随访时有377例患者；331例（87.8%）肾功能已恢复正常，40例（10.6%）未完全恢复，6例（1.6%）已死亡。60岁以上患者中AKI进展为慢性肾脏病或死亡的比例显著较高（P = 0.017）。更严重的AKI与2型糖尿病（P = 0.0042）、高血压（P < 0.0001）及多种合并症（P = 0.0014）相关。无合并症者的AKI病情较轻（P = 0.0004）。即使在AKI早期，死亡率也显著较高（AKI 1期和2期为11%），在3期翻倍（22%）。肾前性病因导致的AKI患者死亡率较低（比值比：0.59，95%置信区间：0.35 - 0.99，P = 0.047）。老年及合并症患者的AKI发病率和死亡率较高。识别有发生AKI高风险的个体对于其预防、早期诊断及恰当治疗至关重要。基础设施、人力、当地研究、AKI报告及记录方面的局限是斯里兰卡为AKI患者提供最佳治疗的关键挑战。
