PDF(Pubmed)
Abstract：
In older adults, epidemiological data on incidence rates (IR) of hospital-acquired acute kidney injury (AKI) are scarce. Also, little is known about trajectories of kidney function before hospitalization with AKI.
We used data from biennial face-to-face study visits from the prospective Berlin Initiative Study (BIS) including community-dwelling participants aged 70+ with repeat estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C. Primary outcome was first incident of hospital-acquired AKI assessed through linked insurance claims data. In a nested case-control study, kidney function decline prior to hospitalization with and without AKI was investigated using eGFR trajectories estimated with mixed-effects models adjusted for traditional cardiovascular comorbidities.
Out of 2020 study participants (52.9% women; mean age 80.4 years) without prior AKI, 383 developed a first incident AKI, 1518 were hospitalized without AKI, and 119 were never hospitalized during a median follow-up of 8.8 years. IR per 1000 person years for hospital-acquired AKI was 26.8 (95% confidence interval (CI): 24.1-29.6); higher for men than women (33.9 (29.5-38.7) vs. 21.2 (18.1-24.6)). IR (CI) were lowest for persons aged 70-75 (13.1; 10.0-16.8) and highest for ≥ 90 years (54.6; 40.0-72.9). eGFR trajectories declined more steeply in men and women with AKI compared to men and women without AKI years before hospitalization. These differences in eGFR trajectories remained after adjustment for traditional comorbidities.
AKI is a frequent in-hospital complication in individuals aged 70 + showing a striking increase of IR with age. eGFR decline was steeper in elderly patients with AKI compared to elderly patients without AKI years prior to hospitalization emphasising the need for long-term kidney function monitoring pre-admission to improve risk stratification.
We used data from biennial face-to-face study visits from the prospective Berlin Initiative Study (BIS) including community-dwelling participants aged 70+ with repeat estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C. Primary outcome was first incident of hospital-acquired AKI assessed through linked insurance claims data. In a nested case-control study, kidney function decline prior to hospitalization with and without AKI was investigated using eGFR trajectories estimated with mixed-effects models adjusted for traditional cardiovascular comorbidities.
Out of 2020 study participants (52.9% women; mean age 80.4 years) without prior AKI, 383 developed a first incident AKI, 1518 were hospitalized without AKI, and 119 were never hospitalized during a median follow-up of 8.8 years. IR per 1000 person years for hospital-acquired AKI was 26.8 (95% confidence interval (CI): 24.1-29.6); higher for men than women (33.9 (29.5-38.7) vs. 21.2 (18.1-24.6)). IR (CI) were lowest for persons aged 70-75 (13.1; 10.0-16.8) and highest for ≥ 90 years (54.6; 40.0-72.9). eGFR trajectories declined more steeply in men and women with AKI compared to men and women without AKI years before hospitalization. These differences in eGFR trajectories remained after adjustment for traditional comorbidities.
AKI is a frequent in-hospital complication in individuals aged 70 + showing a striking increase of IR with age. eGFR decline was steeper in elderly patients with AKI compared to elderly patients without AKI years prior to hospitalization emphasising the need for long-term kidney function monitoring pre-admission to improve risk stratification.
摘要：
在老年人中,关于医院获得性急性肾损伤(AKI)发病率(IR)的流行病学数据很少.此外，关于AKI住院前的肾功能轨迹知之甚少.
我们使用了来自前瞻性柏林倡议研究（BIS）的两年一次面对面研究访问的数据，包括70岁以上的社区居住参与者，根据血清肌酐和胱抑素C重复估计肾小球滤过率（eGFR）。在嵌套病例对照研究中，我们使用eGFR轨迹对有或无AKI患者住院前的肾功能下降进行调查,该轨迹采用混合效应模型对传统心血管合并症进行了校正.
在2020年的研究参与者中（52.9％的女性；平均年龄80.4岁）没有先前的AKI，383发生了第一次事件AKI，1518年没有AKI住院，在中位8.8年的随访期间,119例患者从未住院.医院获得性AKI的每1000人年IR为26.8（95％置信区间（CI）：24.1-29.6）；男性高于女性（33.9（29.5-38.7）21.2(18.1-24.6))。IR（CI）在70-75岁的人群中最低（13.1;10.0-16.8），在≥90岁的人群中最高（54.6;40.0-72.9）。与住院前几年没有AKI的男性和女性相比，患有AKI的男性和女性的eGFR轨迹下降更剧烈。在对传统合并症进行调整后，eGFR轨迹的这些差异仍然存在。
AKI是70岁以上人群中常见的住院并发症，显示IR随年龄显著增加。与住院前几年无AKI的老年患者相比,有AKI的老年患者的eGFR下降更严重,这强调需要在入院前进行长期肾功能监测以改善危险分层.
我们使用了来自前瞻性柏林倡议研究（BIS）的两年一次面对面研究访问的数据，包括70岁以上的社区居住参与者，根据血清肌酐和胱抑素C重复估计肾小球滤过率（eGFR）。在嵌套病例对照研究中，我们使用eGFR轨迹对有或无AKI患者住院前的肾功能下降进行调查,该轨迹采用混合效应模型对传统心血管合并症进行了校正.
在2020年的研究参与者中（52.9％的女性；平均年龄80.4岁）没有先前的AKI，383发生了第一次事件AKI，1518年没有AKI住院，在中位8.8年的随访期间,119例患者从未住院.医院获得性AKI的每1000人年IR为26.8（95％置信区间（CI）：24.1-29.6）；男性高于女性（33.9（29.5-38.7）21.2(18.1-24.6))。IR（CI）在70-75岁的人群中最低（13.1;10.0-16.8），在≥90岁的人群中最高（54.6;40.0-72.9）。与住院前几年没有AKI的男性和女性相比，患有AKI的男性和女性的eGFR轨迹下降更剧烈。在对传统合并症进行调整后，eGFR轨迹的这些差异仍然存在。
AKI是70岁以上人群中常见的住院并发症，显示IR随年龄显著增加。与住院前几年无AKI的老年患者相比,有AKI的老年患者的eGFR下降更严重,这强调需要在入院前进行长期肾功能监测以改善危险分层.
