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Abstract：
BACKGROUND: Acute kidney injury (AKI) incidence is extremely high worldwide, and patients who develop AKI are at increased risk of developing chronic kidney disease (CKD), CKD progression, and end-stage kidney disease (ESKD). However, there is no established treatment strategy for AKI. Based on the idea that exercise has a stabilizing effect on hemodynamics, we hypothesized that rehabilitation would have beneficial renal outcomes in patients with AKI associated with cardiovascular disease. Therefore, the purpose of this study was to determine whether rehabilitation can stabilize hemodynamics and positively impact renal outcomes in patients with AKI associated with cardiovascular disease.
METHODS: In total, 107 patients with AKI associated with cardiovascular disease were enrolled in this single-center retrospective study and were either assigned to the exposure group (n = 36), which received rehabilitation at least once a week for at least 8 consecutive weeks, or to the control group (n = 71). Estimated glomerular filtration rate was assessed at baseline before admission, at the lowest value during hospitalization, and at 3, 12, and 24 months after enrolment. Trends over time (group × time) between the two groups were compared using generalized estimating equations. Moreover, congestive status was assessed by amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and the effect of rehabilitation on congestion improvement was investigated using logistical regression analysis.
RESULTS: The time course of renal function after AKI, from baseline to each of the three timepoints suggested significant differences between the two groups (p < 0.01). However, there was no significant difference between the two groups at any time point in terms of percentage of patients who experienced a 40% estimated glomerular filtration rate reduction from that at baseline. The proportion of patients with improved congestion was significantly higher in the exposure group compared with that in the control group (p = 0.018). Logistic regression analysis showed that rehabilitation was significantly associated with improved congestion (p = 0.021, OR: 0.260, 95%CI: 0.083-0.815).
CONCLUSIONS: Our results suggest that rehabilitation in patients with AKI associated with cardiovascular disease correlates with an improvement in congestion and may have a positive effect on the course of renal function.
METHODS: In total, 107 patients with AKI associated with cardiovascular disease were enrolled in this single-center retrospective study and were either assigned to the exposure group (n = 36), which received rehabilitation at least once a week for at least 8 consecutive weeks, or to the control group (n = 71). Estimated glomerular filtration rate was assessed at baseline before admission, at the lowest value during hospitalization, and at 3, 12, and 24 months after enrolment. Trends over time (group × time) between the two groups were compared using generalized estimating equations. Moreover, congestive status was assessed by amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and the effect of rehabilitation on congestion improvement was investigated using logistical regression analysis.
RESULTS: The time course of renal function after AKI, from baseline to each of the three timepoints suggested significant differences between the two groups (p < 0.01). However, there was no significant difference between the two groups at any time point in terms of percentage of patients who experienced a 40% estimated glomerular filtration rate reduction from that at baseline. The proportion of patients with improved congestion was significantly higher in the exposure group compared with that in the control group (p = 0.018). Logistic regression analysis showed that rehabilitation was significantly associated with improved congestion (p = 0.021, OR: 0.260, 95%CI: 0.083-0.815).
CONCLUSIONS: Our results suggest that rehabilitation in patients with AKI associated with cardiovascular disease correlates with an improvement in congestion and may have a positive effect on the course of renal function.
摘要：
背景：急性肾损伤（AKI）发病率在全球范围内非常高，发生AKI的患者患慢性肾病（CKD）的风险增加，CKD进展,和终末期肾病（ESKD）。然而,目前尚无针对AKI的既定治疗策略.基于运动对血液动力学有稳定作用的观点，我们假设康复治疗对与心血管疾病相关的AKI患者有有益的肾脏结局.因此,本研究的目的是确定康复治疗是否能稳定心血管疾病相关AKI患者的血流动力学并对肾脏结局产生积极影响.
方法：总共，107名与心血管疾病相关的AKI患者被纳入这项单中心回顾性研究，并被分配到暴露组（n=36）。每周至少接受一次康复，至少连续8周，或对照组（n=71）。估计的肾小球滤过率在入院前基线评估，在住院期间的最低值，以及注册后3、12和24个月。使用广义估计方程比较两组之间随时间（组×时间）的趋势。此外，通过氨基末端B型利钠肽前体（NT-proBNP）评估充血状态，并使用后勤回归分析研究了康复对阻塞改善的影响。
结果：AKI后肾功能的时程，从基线到三个时间点中的每个时间点提示两组之间存在显著差异(p<0.01).然而,两组在任何时间点的肾小球滤过率估计比基线下降40%的患者百分比均无显著差异.暴露组充血改善的患者比例明显高于对照组(p=0.018)。Logistic回归分析显示康复与改善充血显著相关(p=0.021,OR:0.260,95CI:0.083～0.815)。
结论：我们的结果表明，与心血管疾病相关的AKI患者的康复与充血的改善相关，并可能对肾功能的病程产生积极影响。
方法：总共，107名与心血管疾病相关的AKI患者被纳入这项单中心回顾性研究，并被分配到暴露组（n=36）。每周至少接受一次康复，至少连续8周，或对照组（n=71）。估计的肾小球滤过率在入院前基线评估，在住院期间的最低值，以及注册后3、12和24个月。使用广义估计方程比较两组之间随时间（组×时间）的趋势。此外，通过氨基末端B型利钠肽前体（NT-proBNP）评估充血状态，并使用后勤回归分析研究了康复对阻塞改善的影响。
结果：AKI后肾功能的时程，从基线到三个时间点中的每个时间点提示两组之间存在显著差异(p<0.01).然而,两组在任何时间点的肾小球滤过率估计比基线下降40%的患者百分比均无显著差异.暴露组充血改善的患者比例明显高于对照组(p=0.018)。Logistic回归分析显示康复与改善充血显著相关(p=0.021,OR:0.260,95CI:0.083～0.815)。
结论：我们的结果表明，与心血管疾病相关的AKI患者的康复与充血的改善相关，并可能对肾功能的病程产生积极影响。
