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AKI 的恢复情况存在差异,主要取决于 AKI 的病因、严重程度和持续时间。[117]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67. https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com
AKI 是死亡的独立危险因素。[10]Wang HE, Muntner P, Chertow GM, et al. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol. 2012;35(4):349-55. https://www.karger.com/Article/FullText/337487 http://www.ncbi.nlm.nih.gov/pubmed/22473149?tool=bestpractice.com [117]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67. https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com [118]Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: systematic review and meta-analysis. Am J Kidney Dis. 2009 Jun;53(6):961-73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726041 http://www.ncbi.nlm.nih.gov/pubmed/19346042?tool=bestpractice.com AKI 的住院死亡率为 6%-80%,存活的 AKI 住院患者的远期死亡率增高。[118]Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: systematic review and meta-analysis. Am J Kidney Dis. 2009 Jun;53(6):961-73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726041 http://www.ncbi.nlm.nih.gov/pubmed/19346042?tool=bestpractice.com
有 6% 入住重症监护病房的 AKI 患者需要接受肾脏替代治疗。[17]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 [117]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67. https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com [119]Tao Li PK, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Int J Organ Transplant Med. 2013;4(1):1-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089304 http://www.ncbi.nlm.nih.gov/pubmed/25013646?tool=bestpractice.com 住院期间,接受透析治疗的 AKI 患者的死亡率超过 50%;多器官功能衰竭的患者死亡风险最大。[14]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 [17]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 [119]Tao Li PK, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Int J Organ Transplant Med. 2013;4(1):1-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089304 http://www.ncbi.nlm.nih.gov/pubmed/25013646?tool=bestpractice.com 死亡率增高主要是因为由潜在疾病和并发症导致的死亡,并不是由 AKI 本身导致。
需要接受肾脏替代治疗的 AKI 患者的 5 年生存率范围为 15%-35%(其中需要依赖长期透析的患者不足 10%)。[120]Rimes-Stigare C, Awad A, Mårtensson J, et al. Long-term outcome after acute renal replacement therapy: a narrative review. Acta Anaesthesiol Scand. 2012 Feb;56(2):138-46. http://www.ncbi.nlm.nih.gov/pubmed/22092145?tool=bestpractice.com
有 5%-7% 的成年患者和多达 16% 的老年患者的 AKI 不可逆转。[121]Bhandari S, Turney JH. Survivors of acute renal failure who do not recover renal function. QJM. 1996 Jun;89(6):415-21. http://www.ncbi.nlm.nih.gov/pubmed/8758044?tool=bestpractice.com 关于既往存在 AKI 是否为导致未来慢性肾脏疾病的一个主要危险因素,目前仍有争议,但有越来越多的证据表明二者之间有很大关联。[122]Rifkin DE, Coca SG, Kalantar-Zadeh K. Does AKI Truly Lead to CKD? J Am Soc Nephrol. 2012 Jun;23(6):979-84. http://www.ncbi.nlm.nih.gov/pubmed/22460531?tool=bestpractice.com [123]Leung KC, Tonelli M, James MT. Chronic kidney disease following acute kidney injury: risk and outcomes. Nat Rev Nephrol. 2013 Feb;9(2):77-85. http://www.ncbi.nlm.nih.gov/pubmed/23247572?tool=bestpractice.com [124]Bucaloiu ID, Kirchner HL, Norfolk ER, et al. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012 Mar;81(5):477-85. http://www.ncbi.nlm.nih.gov/pubmed/22157656?tool=bestpractice.com
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