Muñoz-Sánchez Ana, Martín-Rodríguez Leyre, López-Sánchez Paula, Valdenebro Maria, Serrano-Salazar Maria Luisa, Marques Maria, Portoles Jose
Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, C/Manuel de Falla S/N, Majadahonda, 28222, Madrid, Spain.
Instituto de Investigación Puerta de Hierro-Segovia Arana, IDIPHISA, Madrid, Spain.
J Nephrol. 2025 Aug 1. doi: 10.1007/s40620-025-02367-6.
Acute Kidney Injury (AKI) is frequent and is associated with adverse outcomes.
To analyze the impact of community-acquired and hospital-acquired AKI on in-hospital and five-year post-discharge kidney replacement therapy (KRT) requirement in the pre-COVID era.
We linked the regional health system database of 419,851 admissions to the regional KRT registry. We grouped all admissions into 3 categories: community-acquired AKI, where AKI was the primary diagnosis, and hospital-acquired AKI, where AKI was an additional diagnosis alongside another primary condition. Admissions without this code were grouped into a third category (no AKI). We excluded patients aged under 18 years old, those with previous KRT, and pregnant women. The study was approved by the ethics committee. Patients were followed up for five years after discharge.
Community-acquired AKI accounted for 0.6% of all admissions, associated prolonged average hospital stays, and increased mortality rates. In-hospital KRT administration was required in 3.1% of cases, and after a mean follow-up time of 459 days, 7.2% of these patients began chronic KRT. Hospital-acquired AKI represented 6.1% of all admissions and was associated with the highest mortality rate (22.9% vs 14.4% in the community-acquired AKI group) and the longest average hospital stay (12.6 days vs 7.1 in the no AKI group). Only 0.5% of hospital-acquired AKI cases required KRT during the AKI episode, while 2% of these patients initiated chronic KRT after a mean follow-up time of 594 days.
AKI continues to be a frequent problem in clinical practice, negatively influencing patient morbidity and mortality, and increasing the risk of starting KRT in the medium-long term.
急性肾损伤（AKI）很常见，且与不良后果相关。
分析在新冠疫情之前的时代，社区获得性和医院获得性AKI对住院期间及出院后五年肾脏替代治疗（KRT）需求的影响。
我们将419,851例住院患者的区域卫生系统数据库与区域KRT登记处相链接。我们将所有住院患者分为三类：社区获得性AKI（AKI为主要诊断）、医院获得性AKI（AKI为除另一主要疾病外的附加诊断）。没有此编码的住院患者归为第三类（无AKI）。我们排除了18岁以下的患者、既往接受过KRT的患者和孕妇。该研究获得伦理委员会批准。患者出院后随访五年。
社区获得性AKI占所有住院患者的0.6%，与平均住院时间延长和死亡率增加相关。3.1%的病例需要在住院期间进行KRT，平均随访459天后，这些患者中有7.2%开始进行慢性KRT。医院获得性AKI占所有住院患者的6.1%，与最高死亡率（社区获得性AKI组为14.4%，医院获得性AKI组为22.9%）和最长平均住院时间（无AKI组为7.1天，医院获得性AKI组为12.6天）相关。在AKI发作期间，只有0.5%的医院获得性AKI病例需要KRT，而这些患者中有2%在平均随访594天后开始进行慢性KRT。
AKI在临床实践中仍然是一个常见问题，对患者的发病率和死亡率产生负面影响，并增加中长期开始KRT的风险。
