老年单纯急性肾损伤与AonC近期预后分析

摘要

目的：研究急性肾损伤（ AKI）患者与慢性肾脏病（ CKD）合并AKI（ AonC）患者的预后。方法入选北京友谊医院医疗保健中心2009年8月至2013年10月期间收治的AonC患者147例，男性105例，女性42例，年龄（83．95±7．04）岁；同期单纯AKI患者270例，男性226例，女性44例，年龄（81．75±6．98）岁，比较两组患者近期（1年内）预后。结果单纯AKI患者随访30 d时的病死率高于AonC患者，差异有统计学意义（P＜0．05），随访90 d和1年时的病死率差异无统计学意义（P＞0．05）；两组存活患者的肾功能恢复率差异无统计学意义（P＞0．05）；不同估算肾小球滤过率（eGFR）水平的AonC患者随访30 d、90 d和1年病死率的差异无统计学意义（P＞0．05）。 Cox多因素回归分析表明是否合并CKD与患者30 d病死率无关（P＝0．068），与AKI分期、合并贫血、低蛋白血症、心力衰竭、恶性肿瘤和多器官功能障碍综合征（MODS）相关，肾脏替代治疗（ RRT）为保护性因素。结论老年AKI患者患病率和病死率高，是否合并CKD与近期预后无明显相关。%Objective To analyze the prognosis of the elderly patients with acute kidney injury ( AKI) and those suffering from acute on chronic kidney injury.Methods A total of 147 patients (105 males and 42 females, at a mean age of 83.95 ±7.04) with acute on chronic AKI (AonC) and 270 cases (226 males and 44 females, at a mean age of 81.75 ±6.98) with denovo AKI admitted in our center from August 2009 to October 2013 were enrolled in this study.Their short-term outcomes (within 1 year) were analyzed. Results The 30-day mortality was significantly higher in the AKI than the AonC patients (P<0.05), but there were no differences in that of 90-day and 1-year (P>0.05).No difference was seen in the recovery of renal function between the survivals from the 2 group (P>0.05).There were no differences in the 30-day,90-day,1-year mortalities among the AonC patients with different estimated glomerular filtration rates ( eGFR) .COX multivariate regression analysis showed that complication with chronic kidney disease ( CKD) had no relation with the 30-day mortality (P=0.068), but is associated with AKI stage, anemia,hypoalbuminemia,heart failure, cancer, and multiple organ dysfunction syndrome (MODS).Renal replacement therapy was the protective factor for AonC patients . Conclusion The incidence and mortality of AKI were quite high in the AKI elderly patients .Complication of CKD is not related with their short-term prognosis .