Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study

被引：2407

作者：

Hoste, Eric A. J. ^{[1
,2
,3
]}

Bagshaw, Sean M. ^{[4
]}

Bellomo, Rinaldo ^{[5
]}

Cely, Cynthia M. ^{[6
]}

Colman, Roos ^{[7
]}

Cruz, Dinna N. ^{[8
]}

Edipidis, Kyriakos ^{[9
]}

Forni, Lui G. ^{[10
,11
]}

Gomersall, Charles D. ^{[12
]}

Govil, Deepak ^{[13
]}

Honore, Patrick M. ^{[14
]}

Joannes-Boyau, Olivier ^{[15
]}

Joannidis, Michael ^{[16
]}

Korhonen, Anna-Maija ^{[17
,18
]}

Lavrentieva, Athina ^{[19
]}

Mehta, Ravindra L. ^{[20
]}

Palevsky, Paul ^{[21
,22
,23
]}

Roessler, Eric ^{[24
]}

Ronco, Claudio ^{[25
]}

Uchino, Shigehiko ^{[26
]}

Vazquez, Jorge A. ^{[27
]}

Vidal Andrade, Erick ^{[28
]}

Webb, Steve ^{[29
,30
]}

Kellum, John A. ^{[3
,23
]}

机构：

[1] Univ Ghent, Ghent Univ Hosp, Dept Intens Care Med, B-9000 Ghent, Belgium

[2] Res Fdn Flanders, Brussels, Belgium

[3] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Clin Res Invest & Syst Modelling Acute Illnes CRI, Pittsburgh, PA USA

[4] Univ Alberta, Fac Med & Dent, Div Crit Care Med, Edmonton, AB, Canada

[5] Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia

[6] Univ Miami, Miller Sch Med, Div Pulm Crit Care & Sleep Med, Miami, FL 33136 USA

[7] Univ Ghent, Dept Publ Hlth, B-9000 Ghent, Belgium

[8] Univ Calif San Diego, Dept Med, Div Nephrol Hypertens, San Diego, CA 92103 USA

[9] Hygeia Med Ctr, Athens, Greece

[10] Univ Surrey, Fac Hlth & Med Sci, Dept Intens Care Med, Guildford GU2 7TE, Surrey, England

[11] Univ Surrey, Surrey Peri Operat Anaesthesia Crit Care Res Grp, Royal Surrey Cty Hosp NHS Fdn Trust, Guildford GU2 7TE, Surrey, England

[12] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anaesthesia & Intens Care, Hong Kong, Hong Kong, Peoples R China

[13] Medanta, Inst Crit Care & Anesthesia, Gurgaon, India

[14] VUB Univ, Univ Ziekenhuis Brussel, Dept Intens Care, Brussels, Belgium

[15] CHU Bordeaux, Serv Anesthesie Reanimat 2, F-33000 Bordeaux, France

[16] Med Univ Innsbruck, Dept Internal Med, Div Intens Care & Emergency Med, A-6020 Innsbruck, Austria

[17] Meilahti Univ Hosp, Cent Hosp, Dept Surg, Intens Care Unit,Div Anaesthesia & Intens Care Me, Helsinki, Finland

[18] Univ Helsinki, Dept Clin Sci, Helsinki, Finland

[19] Papanikolaou Gen Hosp, Burn ICU, Thessaloniki, Greece

[20] Univ Calif San Diego, Dept Med, Med Ctr, San Diego, CA 92103 USA

[21] VA Pittsburgh Healthcare Syst, Renal Sect, Pittsburgh, PA USA

[22] Univ Pittsburgh, Sch Med, Dept Med, Renal Electrolyte Div, Pittsburgh, PA 15213 USA

[23] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Ctr Crit Care Nephrol, Pittsburgh, PA 15213 USA

[24] Pontificia Univ Catolica Chile, Fac Med, Dept Nephrol, Santiago, Chile

[25] San Bortolo Hosp, Int Renal Res Inst, Dept Nephrol Dialysis & Transplantat, Vicenza, Italy

[26] Jikei Univ, Sch Med, Dept Anesthesiol, Intens Care Unit, Tokyo, Japan

[27] Clin Modelo Lanus, Dept Crit Care Med, Buenos Aires, DF, Argentina

[28] Hosp Angeles Lomas, Dept Crit Care Med, Mexico City, DF, Mexico

[29] Univ Western Australia, Dept Crit Care Med, Perth, WA 6009, Australia

[30] Royal Perth Hosp, Perth, WA 6001, Australia

来源：

INTENSIVE CARE MEDICINE | 2015年 / 41卷 / 08期

关键词：

Acute kidney injury; Critically ill; Renal replacement therapy; Epidemiology; Kidney function; Hospital mortality; RENAL REPLACEMENT THERAPY; GLOMERULAR-FILTRATION; 90-DAY MORTALITY; RISK-FACTORS; FAILURE; ICU; DEFINITION; CREATININE; INFECTION; IMPACT;

D O I：

10.1007/s00134-015-3934-7

中图分类号：

R4 [临床医学];

学科分类号：

100218 [急诊医学];

摘要：

Current reports on acute kidney injury (AKI) in the intensive care unit (ICU) show wide variation in occurrence rate and are limited by study biases such as use of incomplete AKI definition, selected cohorts, or retrospective design. Our aim was to prospectively investigate the occurrence and outcomes of AKI in ICU patients. The Acute Kidney Injury-Epidemiologic Prospective Investigation (AKI-EPI) study was an international cross-sectional study performed in 97 centers on patients during the first week of ICU admission. We measured AKI by Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and outcomes at hospital discharge. A total of 1032 ICU patients out of 1802 [57.3 %; 95 % confidence interval (CI) 55.0-59.6] had AKI. Increasing AKI severity was associated with hospital mortality when adjusted for other variables; odds ratio of stage 1 = 1.679 (95 % CI 0.890-3.169; p = 0.109), stage 2 = 2.945 (95 % CI 1.382-6.276; p = 0.005), and stage 3 = 6.884 (95 % CI 3.876-12.228; p < 0.001). Risk-adjusted rates of AKI and mortality were similar across the world. Patients developing AKI had worse kidney function at hospital discharge with estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) in 47.7 % (95 % CI 43.6-51.7) versus 14.8 % (95 % CI 11.9-18.2) in those without AKI, p < 0.001. This is the first multinational cross-sectional study on the epidemiology of AKI in ICU patients using the complete KDIGO criteria. We found that AKI occurred in more than half of ICU patients. Increasing AKI severity was associated with increased mortality, and AKI patients had worse renal function at the time of hospital discharge. Adjusted risks for AKI and mortality were similar across different continents and regions.

引用

页码：1411 / 1423

页数：13

共 40 条

[1]

Altman D., 2000, STAT CONFIDENCE CONF

[2]

[Anonymous], 2012, Kidney Int Suppl, V2, DOI [DOI 10.1038/KISUP.2012.1, 10.1038/kisup.2011.37]

[3]

[Anonymous], 2014, Countries and economies

[4]

Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group [J].

Bellomo, R ;

Ronco, C ;

Kellum, JA ;

Mehta, RL ;

Palevsky, P .

CRITICAL CARE, 2004, 8 (04) :R204-R212

[5]

Acute kidney injury [J].

Bellomo, Rinaldo ;

Kellum, John A. ;

Ronco, Claudio .

LANCET, 2012, 380 (9843) :756-766

[6]

Comparison of different equations to assess glomerular filtration in critically ill patients [J].

Carlier, Mieke ;

Dumoulin, Alexander ;

Janssen, Alexander ;

Picavet, Sven ;

Vanthuyne, Steve ;

Van Eynde, Ria ;

Vanholder, Raymond ;

Delanghe, Joris ;

Schoenmakere, Gert De ;

De Waele, Jan J. ;

Hoste, Eric A. J. .

INTENSIVE CARE MEDICINE, 2015, 41 (03) :427-435

[7]

Acute Kidney Injury and Chronic Kidney Disease as Interconnected Syndromes [J].

Chawla, Lakhmir S. ;

Eggers, Paul W. ;

Star, Robert A. ;

Kimmel, Paul L. .

NEW ENGLAND JOURNAL OF MEDICINE, 2014, 371 (01) :58-66

[8]

Risk factors for target non-attainment during empirical treatment with β-lactam antibiotics in critically ill patients [J].

De Waele, Jan J. ;

Lipman, J. ;

Akova, M. ;

Bassetti, M. ;

Dimopoulos, G. ;

Kaukonen, M. ;

Koulenti, D. ;

Martin, C. ;

Montravers, P. ;

Rello, J. ;

Rhodes, A. ;

Udy, A. A. ;

Starr, T. ;

Wallis, S. C. ;

Roberts, J. A. .

INTENSIVE CARE MEDICINE, 2014, 40 (09) :1340-1351

[9]

Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury [J].

Elseviers, Monique M. ;

Lins, Robert L. ;

Van der Niepen, Patricia ;

Hoste, Eric ;

Malbrain, Manu L. ;

Damas, Pierre ;

Devriendt, Jacques .

CRITICAL CARE, 2010, 14 (06)

[10]

Performance and Limitations of Administrative Data in the Identification of AKI [J].

Grams, Morgan E. ;

Waikar, Sushrut S. ;

MacMahon, Blaithin ;

Whelton, Seamus ;

Ballew, Shoshana H. ;

Coresh, Josef .

CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2014, 9 (04) :682-689

← 1 2 3 4 →