Long-Term Follow-Up of Patients after Acute Kidney Injury Patterns of Renal Functional Recovery 英文参考文献.docVIP

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Long-Term Follow-Up of Patients after Acute Kidney Injury Patterns of Renal Functional Recovery 英文参考文献.doc

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Long-Term Follow-Up of Patients after Acute Kidney Injury Patterns of Renal Functional Recovery 英文参考文献

Long-TermFollow-UpofPatientsafterAcuteKidney Injury:PatternsofRenalFunctionalRecovery EtienneMacedo1,DirceM.T.Zanetta2,ReginaC.R.M.Abdulkader1* 1DisciplineofNephrology,SchoolofMedicine,UniversityofSa?oPaulo,Sa?oPaulo,Brazil,2DepartmentofEpidemiology,SchoolofPublicHealth,UniversityofSa?oPaulo, Sa?o Paulo,Brazil Abstract Background and Objectives: Patients who survive acute kidney injury (AKI), especially those with partial renal recovery, presentahigherlong-termmortalityrisk.However,thereisnoconsensusonthebesttimetoassessrenalfunctionafteran episodeofacutekidneyinjuryoragreementonthedefinitionofrenalrecovery.Inaddition,onlylimiteddataregarding predictorsofrecoveryareavailable. Design,Setting,Participants,Measurements:From1984to2009,84adultsurvivorsofacutekidneyinjurywerefollowed bythesamenephrologist(RCRMA)foramediantimeof4.1years.Patientswereseenatleastonceeachyearafterdischarge untilendstagerenaldisease(ESRD)ordeath.Ineachconsultationserumcreatininewasmeasuredandglomerularfiltration rateestimated.Renalrecoverywasdefinedasaglomerularfiltrationratevalue$60mL/min/1.73m2.Amultiplelogistic regressionwasperformedtoevaluatefactorsindependentlyassociatedwithrenalrecovery. Results: The median length of follow-up was 50 months (30–90 months). All patients had stabilized their glomerular filtrationratesby18monthsand83%ofthemstabilizedearlier:upto12months.Renalrecoveryoccurredin16patients (19%)atdischargeandin54(64%)by18months.SixpatientsdiedandfourpatientsprogressedtoESRDduringthefollow up period. Age (OR 1.09, p,0.0001) and serum creatinine at hospital discharge (OR 2.48, p=0.007) were independent factorsassociatedwithnonrenalrecovery.Theacutekidneyinjuryseverity,evaluatedbypeakserumcreatinineandneed fordialysis,wasnotassociatedwithnonrenalrecovery. Conclusions:Renalrecoverymustbeevaluatednoearlierthanoneyearafteranacutekidneyinjuryepisode.Nephrology referralshouldbeconsideredmainlyforolderpatientsandthosewithelevatedserumcreatinineathospitaldischarge. Citation: Macedo E,