| Background and Objectives:Acute kidney injury (AKI) is a kind of complex clinical syndrome with a variety of possible etiology and clinical manifestation. Hospitalized patients with AKI are characterized by serious clinical symptom, high mortality and poor renal survival. Domestic AKI epidemiological studies, mostly are retrospective investigations of single center with small sample, which are not universal in nation. Moreover, these studies lack clear analysis about risk factors of the prognosis mortality and renal survival rate. Therefore, it is urgently needed to analyze the etiology, pathogenetic and prognostic risk factors of the hospitalized patients suffered from AKI, based on Chinese own data with multicenter, multidisciplinary and large sample. The purpose of our work was conducted to make clear of the etiologic disease spectrum, the epidemiological characteristics, the risk factors of clinical outcomes and prognosis (mortality and renal survival rate) of the hospitalized patients with AKI nationwide, by doing the prospective epidemiological studies with national multicenter AKI hospitalized patients. This study will guide the clinician to intervene the susceptibility and exposure to risks of AKI patients as early as possible, and reduce the adverse prognosis of AKI.Methods:(1) Our research adopted joint investigation to study the national multicenter (68 hospitals), involving 1542 patients with AKI in hospital from June 1, 2014 to December 31,2014, among which 368 cases were in a prospective study. We followed the patients up for total 90 days, on the first, third, seventh, fourteenth, twenty-eighth, sixtieth, and ninetieth days after the occurrence of AKI respectively. Inclusion criteria:The AKI was defined according to AKI diagnosis standards of clinical practice guidelines released by KDIGO in March 2012; hospital stays > 24 hours; initial diagnosis and treatment for the first time. Exclusion criteria: Maintenance hemodialysis patients; Kidney transplant patients. (2) Cross-sectional study about 1542 cases hospitalized patients with AKI:analysis of the demography and clinical characteristics of hospitalized patients with AKI, the stage of disease, etiological distribution, concomitant underlying diseases, damage factors of the hospitalized patients with AKI, drug-related AKI, clinical index analysis and the status quo of treatment. (3) Following 368 prospective cases patients up for total 90 days. The in-hospital mortality, the mortality and renal function recovery rate for 90 days was regarded as a prognostic evaluation index. The Kaplan-Meier curve and single factor Cox proportional hazards regression model was used to do the single factor survival analysis, screening statistically significant risk factors to complete the Cox multi-factor survival analysis, to finding out the independent risk factors of in-hospital mortality, mortality for 90 days, renal function recovery rate for 90 days for admitted patients with AKI.Results:(1) It is shown that the AKI hospitalized people between 40-79 years old are the high-risk groups of acute kidney injury. The severity of AKI increased, with the increase of their age. The Nephrology, the Intensive Care Unit, and the Cardiology are the high incidence departments of AKI. (2) It is clear that cardiopulmonary complications, surgery and excessive application of diuretics are the main causes of prerenal AKI in our country. AKI associated with Antibiotic has ranked the first of renal tubular interstitial diseases. The top five etiologies of AKI related to drug are antibiotic, diuretics, contrast agents, ACEI/ARB drugs, and non-steroidal anti-inflammatory drugs respectively. (3) It is also turned out that the infection, antibiotics application, surgery, low blood volume, and low cardiac output are the injury risk factors of hospitalized patients with AKI in our country. The decrease of erythrocyte volume, increase of serum urea nitrogen, rise of blood uric acid, and the increase of serum phosphorus are the risk factors on exacerbation of AKI. (4) It illuminates that chronic kidney disease (CKD), high total bilirubin (TBIL) (≥60 umol/L), and the increase of APACHE Ⅱ score are the independent risk factors for the development of in-hospital mortality, if the patient is 75 years or older. (5) It declares that if the patient is 75 years or older, chronic kidney disease (CKD), growth of leukocyte count (WBC) (≥12.00 × 109/L), and the increase of APACHE Ⅱ score are the independent risk factors of the increase of mortality during the follow-up of 90 days. (6) It also declares that if the patient is 65 years or older, associated with chronic kidney disease (CKD), AKI stage, and rehydration treatment (protective factors) are the independent risk factors of renal function recovery rate during the 90 days’ follow-up in AKI patients in China.Conclusion:The elderly population are the high-risk groups and risk factor of increased mortality and renal function recovery insufficiency. Medical technology and the wide application of drugs are the epidemio logical characteristics and result in the rise in hospitalized patients with AKI in our country. Chronic kidney disease, the increase of white blood cell count, and APACHE Ⅱ score are the major risk factors to evaluate mortality in patients with AKI. Chronic kidney disease, AKI stage, and rehydration treatment (protective factors) are the independent risk factors affecting the long-term renal survival rate in patients with AKI. |
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