Njurfysiologi och behandling av njursvikt课件.ppt

* 1 INTRODUCTION: There is limited information on whether the incidence of acute kidney injury (AKI) in critically ill patients has changed over time and there is controversy on whether its outcome has improved. METHODS: We interrogated the Australian New Zealand Intensive Care Society Adult Patient Database to obtain data on all adult admissions to 20 Australian intensive care units (ICUs) for or= 24 hours from 1 January 1996 to 31 December 2005. Trends in incidence and mortality for ICU admissions associated with early AKI were assessed. RESULTS: There were 91,254 patient admissions to the 20 study ICUs, with 4,754 cases of AKI, for an estimated crude cumulative incidence of 5.2% (95% confidence interval, 5.1 to 5.4). The incidence of AKI increased during the study period, with an estimated annual increment of 2.8% (95% confidence interval, 1.0 to 5.6, P = 0.04). The crude hospital mortality was significantly higher for patients with AKI than those without (42.7% versus 13.4%; odds ratio, 4.8; 95% confidence interval, 4.5 to 5.1; P 0.0001). There was also a decrease in AKI crude mortality (annual percentage change, -3.4%; 95% confidence interval, -4.7 to -2.12; P 0.001), however, which was not seen in patients without AKI. After covariate adjustment, AKI remained associated with a higher mortality (odds ratio, 1.23; 95% confidence interval, 1.14 to 1.32; P 0.001) and there was a declining trend in the odds ratio for hospital mortality. CONCLUSION: Over the past decade, in a large cohort of critically ill patients admitted to 20 Australian ICUs, there has been a significant rise in the incidence of early AKI while the mortality associated with AKI has declined. 2 Kontrastinducerad nefropati, prevention Acetylcystein Motstridiga resultat i meta-analyser Peroral dos 600-1200 mg x2 xII Intraven?s dos 150 mg/kg pre (ca 10 g) 12,5 mg/kg/h i 4 h post (ca 4 g)  F?rebyggande ?tg?rder Leversvikt Hepatorenalt syndrom Albumin Spontan bakteriell peritonit vid cirrhos