已发表论文

在无之前已存在的慢性肾病的非常老年患者中的 AKI:使用 KDIGO 标准诊断 AKI 的 48 小时窗口和 7 天窗口比较

 

Authors Li Q, Zhao M, Wang X

Received 17 January 2018

Accepted for publication 22 March 2018

Published 20 June 2018 Volume 2018:13 Pages 1151—1160

DOI https://doi.org/10.2147/CIA.S162899

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Wu

Objectives: To compare the differences between the Kidney Disease Improving Global Outcomes (KDIGO) criteria of the 48-hour window and the 7-day window in the diagnosis of acute kidney injury (AKI) in very elderly patients, as well as the relationship between the 48-hour and 7-day windows for diagnosis and 90-day mortality.
Patients and methods: We retrospectively enrolled very elderly patients (≥75 years old) from the geriatrics department of the Chinese PLA General Hospital between January 2007 and December 2015. AKI patients were divided into 48-hour and 7-day groups by their diagnosis criteria. AKI patients were divided into survivor and nonsurvivor groups by their outcomes within 90 days after diagnosis of AKI.
Results: In total, 652 patients were included in the final analysis. The median age of the cohort was 87 (84–91) years, the majority (623, 95.6%) of whom were male. Of the 652 AKI patients, 334 cases (51.2%) were diagnosed with AKI by the 48-hour window for diagnosis, while 318 cases (48.8%) were by the 7-day window for diagnosis. The 90-day mortality was 42.5% in patients with 48-hour window AKI and 24.2% in patients with 7-day window AKI. Kaplan–Meier curves showed that 90-day mortality was lower in the 7-day window AKI group than in the 48-hour window AKI group (log rank: <0.001). Multivariate analysis by the Cox model revealed that 48-hour window for diagnosis hazard ratio (HR=1.818; 95% CI: 1.256–2.631; =0.002) was associated with higher 90-day mortality.
Conclusion: The 90-day mortality was higher in 48-hour window AKI than in 7-day window AKI in very elderly patients. The 48-hour KDIGO window definition may be less sensitive. The 48-hour KDIGO window definition is significantly better correlated with subsequent mortality and is, therefore, still appropriate for clinical use. Finding early, sensitive biomarkers of kidney damage is a future direction of research.
Keywords: acute kidney injury, AKI diagnosis time, very elderly, short-term mortality




Figure 1 Flow chart of patient inclusion and exclusion.