Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (2): 208-213    DOI: 10.3785/j.issn.1008-9292.2016.03.15
综述     
中国住院患者急性肾损伤流行病学调查现状
郎夏冰, 杨毅, 陈江华
浙江大学医学院附属第一医院肾脏病中心, 浙江 杭州 310003
Epidemiology of acute kidney injury in hospitalized patients in China
LANG Xiabing, YANG Yi, CHEN Jianghua
Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
全文: PDF(966 KB)  
摘要: 

急性肾损伤是影响住院患者住院时间、预后以及医疗费用的重要疾病之一,涵盖从轻度血肌酐升高到肾功能衰竭需要替代治疗的一系列疾病谱。随着对疾病重视程度的提高,相关流行病学研究也越来越多,尤其是近年来,国内一些高质量的大样本、多中心研究成果陆续发表。但是,由于地区经济发展水平及目标人群、客观观察指标的选择和检测、基于急性肾损伤诊断定义的研究策略等的不同,住院患者急性肾损伤流行病学研究的结果仍有较大异质性,国内报道的急性肾损伤发病率明显低于发达国家。本文对中国住院患者急性肾损伤的流行病学研究现况和存在的问题进行了分析,旨在引起临床和相关卫生工作系统人员的重视,为设计更加客观的流行病学研究策略提供借鉴,以期获得详实的流行病学数据,为实现中国急性肾损伤的零病死率计划而努力。
关键词 ： 肾/损伤,  急性病,  流行病学,  数据收集,  综述    
Abstract：

Acute kidney injury (AKI) is a disease spectrum ranging from minimal elevation of serum creatinine to complete renal failure. It is significantly associated with increased mortality, length of hospital stay and medical care cost. With the increasing awareness of the importance of AKI, several high quality and multicenter epidemiological studies have been published recently in China. However, the results differ a lot due to the differences in regional economic development, the selection of target population and testing indicators, the disease definition and study strategies. The reported incidence of AKI in China is much lower than that in the developed countries. This article will analyze the current status and the problems facing AKI epidemiological studies of hospitalized patients with our own data and those from literature. The article intends to clarify the burden of AKI,to increase the awareness of AKI among clinicians and policy makers for achieving the goal of "zero by 2025" in China.
Key words： Kidney /injuries    Acute disease    Epidemiology    Data collection    Review
收稿日期: 2015-11-18     
CLC:  R69  
基金资助:

"十二五"国家科技支撑计划(2011BAI10B07)
通讯作者: 陈江华(1958-),男,硕士,教授,主任医师,博士生导师,主要从事肾脏病学、肾移植研究;E-mail:chenjianghua@zju.edu.cn     E-mail: chenjianghua@zju.edu.cn
作者简介: 郎夏冰(1988-),女,博士研究生,主要从事急性肾损伤研究;E-mail:langxiabing_69@163.com
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　

引用本文:

郎夏冰 等. 中国住院患者急性肾损伤流行病学调查现状[J]. 浙江大学学报（医学版）, 2016, 45(2): 208-213.
LANG Xiabing, YANG Yi, CHEN Jianghua. Epidemiology of acute kidney injury in hospitalized patients in China. Journal of ZheJiang University(Medical Science), 2016, 45(2): 208-213.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.03.15      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I2/208

[1] EKNOYAN G. Emergence of the concept of acute renal failure[J]. Am J Nephrol, 2002, 22(2-3):225-230.
[2] BYWATERS E G, BEALL D. Crush injuries with impairment of renal function[J]. Br Med J, 1941, 1(4185):427-432.
[3] BRIVET F G, KLEINKNECHT D J, LOIRAT P, et al. Acute renal failure in intensive care units-causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French study group on acute renal failure[J]. Crit Care Med, 1996, 24(2):192-198.
[4] LIANO F, PASCUAL J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid acute renal failure study group[J]. Kidney Int, 1996, 50(3):811-818.
[5] UCHINO S, KELLUM J A, BELLOMO R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study[J]. JAMA, 2005, 294(7):813-818.
[6] BELLOMO R, RONCO C, KELLUM J A, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group[J]. Crit Care, 2004, 8(4):R204-R212.
[7] MEHTA R L, KELLUM J A, SHAH S V, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury[J]. Crit Care, 2007, 11(2):R31.
[8] LEWINGTON A, KANAGASUNDARAM S. Renal association clinical practice guidelines on acute kidney injury[J]. Nephron Clin Pract, 2011, 118(Suppl 1):c349-c390.
[9] CERDA J, LAMEIRE N, EGGERS P, et al. Epidemiology of acute kidney injury[J]. Clin J Am Soc Nephrol, 2008, 3(3):881-886.
[10] LINDER A, FJELL C, LEVIN A, et al. Small acute increases in serum creatinine are associated with decreased long-term survival in the critically ill[J]. Am J Respir Crit Care Med, 2014, 189(9):1075-1081.
[11] JAMES M T, GHALI W A, KNUDTSON M L, et al. Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography[J]. Circulation, 2011, 123(4):409-416.
[12] CHAWLA L S, EGGERS P W, STAR R A, et al. Acute kidney injury and chronic kidney disease as interconnected syndromes[J]. N Engl J Med, 2014, 371(1):58-66.
[13] FISCHER M J, BRIMHALL B B, LEZOTTE D C, et al. Uncomplicated acute renal failure and hospital resource utilization: a retrospective multicenter analysis[J]. Am J Kidney Dis, 2005, 46(6):1049-1057.
[14] LAMEIRE N H, BAGGA A, CRUZ D, et al. Acute kidney injury: an increasing global concern[J]. Lancet, 2013, 382(9887):170-179.
[15] REMUZZI G, HORTON R. Acute renal failure: An unacceptable death sentence globally[J]. Lancet, 2013, 382(9910):2041-2042.
[16] FRIEL S, BOWEN K, CAMPBELL-LENDRUM D, et al. Climate change, noncommunicable diseases, and development: the relationships and common policy opportunities[J]. Annu Rev Public Health, 2011, 32:133-147.
[17] 李立明,王艳红,吕 筠.流行病学发展的回顾与展望[J].中华疾病控制杂志,2008,12(4) : 304-308. LI Liming, WANG Yanhong, LYN Jun. Epidemiology: history and challenges[J]. Chinese Journal of Disease Control & Prevention, 2008,12(4):304-308.(in Chinese)
[18] LEWINGTON A J, CERDA J, MEHTA R L. Raising awareness of acute kidney injury: a global perspective of a silent killer[J]. Kidney Int, 2013, 84(3):457-467.
[19] SUSANTITAPHONG P, CRUZ D N, CERDA J, et al. World incidence of AKI: a meta-analysis[J]. Clin J Am Soc Nephrol, 2013, 8(9):1482-1493.
[20] SRISAWAT N, KELLUM J A. Acute kidney injury: definition, epidemiology, and outcome[J]. Curr Opin Crit Care, 2011, 17(6):548-555.
[21] UCHINO S, BELLOMO R, GOLDSMITH D, et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients[J]. Crit Care Med, 2006, 34(7):1913-1917.
[22] FANG Y, DING X, ZHONG Y, et al. Acute kidney injury in a Chinese hospitalized population[J]. Blood Purif, 2010, 30(2):120-126.
[23] WEN J, CHENG Q, ZHAO J, et al. Hospital-acquired acute kidney injury in Chinese very elderly persons[J]. J Nephrol, 2013, 26(3):572-579.
[24] LU R, MUCINO-BERMEJO M J, ARMIGNACCO P, et al. Survey of acute kidney injury and related risk factors of mortality in hospitalized patients in a third-level urban hospital of shanghai[J]. Blood Purif, 2014, 38(2):140-148.
[25] YANG L, XING G, WANG L, et al. Acute kidney injury in China: a cross-sectional survey[J]. Lancet, 2015, 386(10002):1465-1471.
[26] XU X, NIE S, LIU Z, et al. Epidemiology and clinical correlates of AKI in Chinese hospitalized adults[J]. Clin J Am Soc Nephrol, 2015, 10(9):1510-1518.
[27] THOMAS M E, BLAINE C, DAWNAY A, et al. The definition of acute kidney injury and its use in practice[J]. Kidney Int, 2015, 87(1):62-73.
[28] ANAND S, CRUZ D N, FINKELSTEIN F O. Understanding acute kidney injury in low resource settings: a step forward[J]. BMC Nephrol, 2015, 16:5.
[29] HWANG Y J, SHARIFF S Z, GANDHI S, et al. Validity of the international classification of diseases, tenth revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission[J]. BMJ Open, 2012, 2(6): e001821. doi:10.1136/bmjopen-2012-001821.
[30] WANG H E, JAIN G, GLASSOCK R J, et al. Comparison of absolute serum creatinine changes versus kidney disease: improving global outcomes consensus definitions for characterizing stages of acute kidney injury[J]. Nephrol Dial Transplant, 2013, 28(6):1447-1454.
[31] PICKERING J W, FRAMPTON C M, WALKER R J, et al. Four hour creatinine clearance is better than plasma creatinine for monitoring renal function in critically ill patients[J]. Crit Care, 2012, 16(3):R107.
[32] RABITO C A, PANICO F, RUBIN R, et al. Noninvasive, real-time monitoring of renal function during critical care[J]. J Am Soc Nephrol, 1994, 4(7):1421-1428.
[33] MANDELBAUM T, LEE J, SCOTT D J, et al. Empirical relationships among oliguria, creatinine, mortality, and renal replacement therapy in the critically ill[J]. Intensive Care Med, 2013, 39(3):414-419.
[34] PROWLE J R, LIU Y L, LICARI E, et al. Oliguria as predictive biomarker of acute kidney injury in critically ill patients[J]. Crit Care, 2011, 15(4):R172.
[35] WONG H R, LINDSELL C J, PETTILA V, et al. A multibiomarker-based outcome risk stratification model for adult septic shock [J]. Crit Care Med, 2014, 42(4):781-789.
[36] KOYNER J L, SHAW A D, CHAWLA L S, et al. Tissue inhibitor metalloproteinase-2 (TIMP-2)-IGF-binding protein-7(IGFBP7) levels are associated with adverse long-term outcomes in patients with AKI[J]. J Am Soc Nephrol, 2015, 26(7):1747-1754.
[37] BASU R K, WONG H R, KRAWCZESKI C D, et al. Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery[J]. J Am Coll Cardiol, 2014, 64(25):2753-2762.
[38] VAIDYA V S, OZER J S, DIETERLE F, et al. Kidney injury molecule-1 outperforms traditional biomarkers of kidney injury in preclinical biomarker qualification studies[J]. Nat Biotechnol, 2010, 28(5):478-485.
[39] ZENG X, MCMAHON G M, BRUNELLI S M, et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals[J]. Clin J Am Soc Nephrol, 2014, 9(1):12-20.
[40] SHEMA L, ORE L, GERON R, et al. Hospital-acquired acute kidney injury in Israel[J]. Isr Med Assoc J, 2009, 11(5):269-274.
[41] SAOUR M, KLOUCHE K, DERAS P, et al. Assessment of modification of diet in renal disease equation to predict reference serum creatinine value in severe trauma patients: lessons from an observational study of 775 cases[J]. Ann Surg, 2016, 263(4):814-820.
[1] 马婷婷,王毅,陈晓倩,赵筱萍. 液相色谱-质谱联用导向的黄葵胶囊肾保护活性物质研究[J]. 浙江大学学报（医学版）, 2017, 46(1): 66-73.
[2] 郑艳榕,张翔南,陈忠. Nix介导的线粒体自噬机制的研究进展[J]. 浙江大学学报（医学版）, 2017, 46(1): 92-96.
[3] 李文龙,瞿海斌. 近红外光谱应用于中药质量控制及生产过程监控的研究进展[J]. 浙江大学学报（医学版）, 2017, 46(1): 80-88.
[4] 高思倩,沈咏梅,耿福能,李艳华,高建青. 糖尿病溃疡动物模型的建立及相关治疗研究进展[J]. 浙江大学学报（医学版）, 2017, 46(1): 97-105.
[5] 王颖,汪仪,陈忠. 中枢胆碱能系统与癫痫关系的研究进展[J]. 浙江大学学报（医学版）, 2017, 46(1): 15-21.
[6] 高思倩,沈咏梅,耿福能,李艳华,高建青. 颞叶癫痫与海马成体神经再生[J]. 浙江大学学报（医学版）, 2017, 46(1): 97-105.
[7] 封盛 等. 糖皮质激素受体信号通路在膀胱癌治疗中的作用研究进展[J]. 浙江大学学报（医学版）, 2016, 45(6): 655-660.
[8] 李统宇 等. 杜氏肌营养不良疾病模型及基因治疗研究进展[J]. 浙江大学学报（医学版）, 2016, 45(6): 648-654.
[9] 曹鹏 等. 双氢青蒿素抗肿瘤分子生物学机制研究进展[J]. 浙江大学学报（医学版）, 2016, 45(5): 501-507.
[10] 李亭亭 等. 中性粒细胞在哮喘中作用的研究进展[J]. 浙江大学学报（医学版）, 2016, 45(5): 544-549.
[11] 王雪 等. TANK结合激酶1在抗病毒免疫应答中的作用研究进展[J]. 浙江大学学报（医学版）, 2016, 45(5): 550-557.
[12] 杜苗苗 等. 钙化性主动脉瓣疾病药物治疗研究进展[J]. 浙江大学学报（医学版）, 2016, 45(4): 432-438.
[13] 何斌 等. 贝伐珠单克隆抗体在难治性子宫颈癌中的应用进展[J]. 浙江大学学报（医学版）, 2016, 45(4): 395-402.
[14] 历雪莹 等. DNA甲基化及其靶向治疗在急性髓系白血病中的研究进展[J]. 浙江大学学报（医学版）, 2016, 45(4): 387-394.
[15] 竺天虹 等. 上皮间充质转化介导子宫内膜异位症发生发展的研究进展[J]. 浙江大学学报（医学版）, 2016, 45(4): 439-445.