关于 AKI 发病率的报道不一,存在诊断、定义标准以及出院编码不同等混杂因素。[6]Centers for Disease Control and Prevention (CDC). Hospitalization discharge diagnoses for kidney disease: United States, 1980-2005. MMWR Morb Mortal Wkly Rep. 2008 Mar 28;57(12):309-12.
http://www.ncbi.nlm.nih.gov/pubmed/18368005?tool=bestpractice.com
[7]Ali T, Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007 Apr;18(4):1292-8.
https://jasn.asnjournals.org/content/18/4/1292.long
http://www.ncbi.nlm.nih.gov/pubmed/17314324?tool=bestpractice.com
依据涵盖 2017 年 3 个月期间英格兰 910 万人口的英国肾脏登记处数据估计,每年的 AKI 发生率为每百万人口 10,400 人(95% CI 每百万人口 10,000-10,400)。[8]Think Kidneys. Reporting the rate of acute kidney injury (AKI) within England – the current state of the NHS AKI Master Patient Index and Registry. January 2018 [internet publication].
https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2018/03/Reporting-the-rate-of-AKI-January-2018.pdf
急症入院患者中 10% 至 20% 存在 AKI,该病住院死亡率 >20%。[3]National Institute for Health and Care Excellence. Acute kidney injury: prevention, detection and management. December 2019 [internet publication].
https://www.nice.org.uk/guidance/ng148
[9]Think Kidneys. Acute kidney injury best practice guidance: responding to AKI warning stage test results for adults in primary care. April 2016 [internet publication].
https://www.thinkkidneys.nhs.uk/aki/wp-content/uploads/sites/2/2016/10/RespondingtoAKI-Warning-Stage-Test-Results-for-Adults-in-Primary-Care.pdf
[10]Selby NM, Kolhe NV, McIntyre CW, et al. Defining the cause of death in hospitalised patients with acute kidney injury. PLoS One. 2012 Nov 2;7(11):e48580.
https://www.doi.org/10.1371/journal.pone.0048580
http://www.ncbi.nlm.nih.gov/pubmed/23133643?tool=bestpractice.com
ICU 中 AKI 的总发病率更高,为 20%-50%,并且相关死亡率超过 50%。[11]Case J, Khan S, Khalid R, et al. Epidemiology of acute kidney injury in the intensive care unit. Crit Care Res Pract. 2013;2013:479730.
https://www.hindawi.com/journals/ccrp/2013/479730/
http://www.ncbi.nlm.nih.gov/pubmed/23573420?tool=bestpractice.com
[12]Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019 Nov 23;394(10212):1949-64.
http://www.ncbi.nlm.nih.gov/pubmed/31777389?tool=bestpractice.com
有证据表明,AKI 正变得越来越普遍,原因可能是对发生 AKI 这一并发症风险较高的老年患者进行更积极的内科和外科干预。[13]Kanagasundaram S, Ashley C, Bhojani S, et al. Renal Association clinical practice guideline acute kidney injury (AKI). August 2019 [internet publication].
https://renal.org/wp-content/uploads/2017/07/FINAL-AKI-Guideline.pdf
一项研究发现,1996 年至 2003 年,在大量住院患者中,不需要透析治疗的 AKI 发生率从每 100,000 人年 323 例增至每 100,000 人年 522 例。[14]Hsu CY, McCulloch CE, Fan D, et al. Community-based incidence of acute renal failure. Kidney Int. 2007 Jul;72(2):208-12.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673495/
http://www.ncbi.nlm.nih.gov/pubmed/17507907?tool=bestpractice.com
已制定针对 AKI 临床结局的预测评分,但成功率不一。[15]Ohnuma T, Uchino S, Toki N, et al. External validation for acute kidney injury severity scores: a multicenter retrospective study in 14 Japanese ICUs. Am J Nephrol. 2015;42(1):57-64.
http://www.ncbi.nlm.nih.gov/pubmed/26337793?tool=bestpractice.com
[16]Poukkanen M, Vaara ST, Reinikainen M, et al. Predicting one-year mortality of critically ill patients with early acute kidney injury: data from the prospective multicenter FINNAKI study. Crit Care. 2015 Mar 27;19:125.
https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-0848-2
http://www.ncbi.nlm.nih.gov/pubmed/25887685?tool=bestpractice.com
急性肾小管坏死(Acute tubular necrosis, ATN)为 45% AKI 患者的病因。在重症监护病房患者中,19% 的 ATN 由脓毒症导致。在其他病因中,肾前性 AKI、梗阻、肾小球肾炎、血管炎、急性间质性肾炎、慢性肾脏病急性恶化和动脉粥样硬化栓塞性损伤占大部分。[17]Mehta R, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21.
http://www.ncbi.nlm.nih.gov/pubmed/15458458?tool=bestpractice.com
[18]Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996 Sep;50(3):811-8.
http://www.ncbi.nlm.nih.gov/pubmed/8872955?tool=bestpractice.com
造影剂肾病的发病率不一,且据报道是 AKI 住院患者第三大常见的病因。一项针对 7500 例因冠状动脉病变行经皮介入手术患者的研究显示,在所有患者中,有 3.3% 的患者发生了AKI(急性肾损伤的定义为血清肌酐升高≥38 μmol/L (0.5mg/dL),在基线肌酐水平≥153 μmol/L (2.0 mg/dL) 的患者中,25% 发生了AKI。[19]Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002 May 14;105(19):2259-64.
https://www.ahajournals.org/doi/full/10.1161/01.cir.0000016043.87291.33
http://www.ncbi.nlm.nih.gov/pubmed/12010907?tool=bestpractice.com
有 7% 的 AKI 住院患者需要接受肾脏替代治疗。[20]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
在重症监护病房中,需要进行透析的多器官功能衰竭患者的死亡率超过 50%。[17]Mehta R, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21.
http://www.ncbi.nlm.nih.gov/pubmed/15458458?tool=bestpractice.com
[18]Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996 Sep;50(3):811-8.
http://www.ncbi.nlm.nih.gov/pubmed/8872955?tool=bestpractice.com
[20]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
肌酐轻微增高 (≥26.5 μmol/L [0.3 mg/dL]) 与住院患者的死亡风险增加、慢性肾脏病的风险增加相关,并且与进展至终末期肾衰竭的几率增加相关。