Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit

ABSTRACT Objective: To describe the epidemiology of acute kidney injury, its relationship to chronic kidney disease, and the factors associated with its incidence. Methods: A cohort study and follow-up were conducted in an intensive care unit in Montevideo, Uruguay. We included patients admitted between November 2014 and October 2015 who were older than 15 years of age and who had at least two measurements of serum creatinine. We excluded patients who were hospitalized for less than 48 hours, patients who died at the time of hospitalization, and patients with chronic renal disease who were on hemodialysis or peritoneal dialysis. There were no interventions. Acute kidney injury was defined according to the criteria set forth in Acute Kidney Injury Disease: Improving Global Outcomes, and chronic kidney disease was defined according to the Chronic Kidney Disease Work Group. Results: We included 401 patients, 56.6% male, median age of 68 years (interquartile range (IQR) 51-79 years). The diagnosis at admission was severe sepsis 36.3%, neurocritical 16.3%, polytrauma 15.2%, and other 32.2%. The incidence of acute kidney injury was 50.1%, and 14.1% of the patients suffered from chronic kidney disease. The incidence of acute septic kidney injury was 75.3%. Mortality in patients with or without acute kidney injury was 41.8% and 14%, respectively (p < 0.001). In the multivariate analysis, the most significant variables for acute kidney injury were chronic kidney disease (odds ratio (OR) 5.39, 95%CI 2.04 - 14.29, p = 0.001), shock (OR 3.94, 95%CI 1.72 - 9.07, p = 0.001), and severe sepsis (OR 7.79, 95%CI 2.02 - 29.97, p = 0.003). Conclusion: The incidence of acute kidney injury is high mainly in septic patients. Chronic kidney disease was independently associated with the development of acute kidney injury.

摘要 研究目的：描述急性肾损伤（acute kidney injury）的流行病学特征、其与慢性肾脏病（chronic kidney disease）的关联，以及与急性肾损伤发病相关的影响因素。
研究方法：本研究在乌拉圭蒙得维的亚的一所重症监护病房开展队列研究及随访。纳入2014年11月至2015年10月期间收治的、年龄≥15岁且至少完成2次血清肌酐（serum creatinine）检测的患者。排除住院时长不足48小时、住院期间离世的患者，以及患有慢性肾脏病且需接受血液透析（hemodialysis）或腹膜透析（peritoneal dialysis）的患者。本研究无任何干预措施。急性肾损伤依据改善全球肾脏病预后组织（Kidney Disease: Improving Global Outcomes, KDIGO）发布的标准进行判定，慢性肾脏病则依据慢性肾脏病工作组（Chronic Kidney Disease Work Group）的定义进行诊断。
研究结果：本研究共纳入401例患者，其中男性占56.6%，中位年龄为68岁（四分位间距（interquartile range, IQR）51~79岁）。入院初始诊断为重症脓毒症者占36.3%，神经重症者占16.3%，多发创伤者占15.2%，其他病症者占32.2%。急性肾损伤的发生率为50.1%，14.1%的患者合并慢性肾脏病。脓毒症相关性急性肾损伤的发生率为75.3%。合并与未合并急性肾损伤患者的病死率分别为41.8%与14.0%（p < 0.001）。多因素分析显示，与急性肾损伤发病显著相关的变量包括慢性肾脏病（比值比（odds ratio, OR）=5.39，95%置信区间（confidence interval, CI）2.04~14.29，p=0.001）、休克（OR=3.94，95%CI 1.72~9.07，p=0.001）以及重症脓毒症（OR=7.79，95%CI 2.02~29.97，p=0.003）。
研究结论：急性肾损伤的发生率较高，尤其多见于脓毒症患者。慢性肾脏病是急性肾损伤发病的独立危险因素。