Risk factors of acute kidney injury occurrence in the intensive care unit

doi:10.3877/cma.j.issn.2095-3216.2023.02.006

Abstract

Abstract:

As a clinical syndrome, acute kidney injury is common in hospitalized patients, especially in critically ill patients. In the intensive care unit (ICU), the incidence rate of AKI is 30%-50%, and the mortality rate is even more than 50%. There are many risk factors of AKI occurrence in ICU inpatients, including old age, sepsis, surgery, trauma, burns, heart failure, nephrotoxin, mechanical ventilation, high scores of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Sequential Organ Failure Assessment (SOFA), history of chronic kidney disease, history of chronic liver disease, diabetes, hypertension, etc. Early prediction of AKI occurrence in ICU is helpful to reduce the incidence and mortality of AKI. This article reviewed the risk factors of AKI occurrence in ICU.

Key words: Acute kidney injury, Intensive care unit, Risk factors

Rui Wang, Xi Qiao. Risk factors of acute kidney injury occurrence in the intensive care unit[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(02): 93-96.

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References 40

[1]	Kellum JA, Romagnani P, Ashuntantang G, et al. Acute kidney injury [J]. Nat Rev Dis Primers, 2021, 7(1): 52.
[2]	陈晨，陈园园，刘欣怡，等. ICU病人急性肾损伤危险因素的Meta分析[J]. 护理研究，2021, 35(9): 1588-1594.
[3]	Lunyera J, Clare RM, Chiswell K, et al. Racial differences in AKI incidence following percutaneous coronary intervention [J]. J Am Soc Nephrol, 2021, 32(3): 654-662.
[4]	Yang L, Xing G, Wang L, et al. Acute kidney injury in China: a cross-sectional survey [J]. Lancet, 2015, 386(10002): 1465-1471.
[5]	Santos RPD, Carvalho ARS, Peres LAB, et al. An epidemiologic overview of acute kidney injury in intensive care units [J]. Rev Assoc Med Bras, 2019, 65(8): 1094-1101.
[6]	陈泳清，伍民生. ICU危重患者急性肾损伤流行病学研究现状[J]. 中国临床研究，2021, 34(1): 122-125.
[7]	Chronopoulos A, Rosner MH, Cruz DN, et al. Acute kidney injury in elderly intensive care patients: a review [J]. Intensive Care Med, 2010, 36(9): 1454-1464.
[8]	Rosner MH. Acute kidney injury in the elderly [J]. Clin Geriatr Med, 2013, 29(3): 565-578.
[9]	Toyama T, Kitagawa K, Oshima M, et al. Age differences in the relationships between risk factors and loss of kidney function: a general population cohort study [J]. BMC Nephrol, 2020, 21(1): 477.
[10]	Medina-Liabres KRP, KIM S. Continuous renal replacement therapy in elderly with acute kidney injury [J]. Korean J Intern Med, 2020, 35(2): 284-294.
[11]	王海萍，孙晶，王荣. 肾脏衰老与老年肾脏疾病的研究进展[J]. 老年医学研究，2021, 2(5): 51-55.
[12]	Rewa O, Bagshaw SM. Acute kidney injury-epidemiology, outcomes and economics [J]. Nat Rev Nephrol, 2014, 10(4): 193-207.
[13]	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3) [J]. JAMA, 2016, 315(8): 801-810.
[14]	康凌垲，李小悦，张倩. 脓毒症相关急性肾损伤发病机制和新型生物标志物研究进展[J]. 实用医学杂志，2021, 37(6): 705-708.
[15]	Peerapornratana S, Manrique-Caballero CL, Gómez H, et al. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment [J]. Kidney Int, 2019, 96(5): 1083-1099.
[16]	Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment [J]. Nat Rev Nephrol, 2017, 13(11): 697-711.
[17]	Li S, Liu M, Liu X, et al. Associated factors and short-term mortality of early versus late acute kidney injury following on-pump cardiac surgery [J]. Interact Cardiovasc Thorac Surg, 2022, 35(3): ivac118.
[18]	Li S, Wang S, Priyanka P, et al. Acute kidney injury in critically ill patients after noncardiac major surgery: early versus late onset [J]. Crit Care Med, 2019, 47(6): e437-e444.
[19]	Kellum JA, Prowle JR. Paradigms of acute kidney injury in the intensive care setting [J]. Nat Rev Nephrol, 2018, 14(4): 217-230.
[20]	Perkins ZB, Captur G, Bird R, et al. Trauma induced acute kidney injury [J]. PLoS One, 2019, 14(1): e0211001.
[21]	Sul YH, Lee JY, Kim SH, et al. Risk factors for acute kidney injury in critically ill patients with torso injury: a retrospective observational single-center study [J]. Medicine, 2021, 100(29): e26723.
[22]	汤文君，李世军. 创伤相关急性肾损伤[J]. 肾脏病与透析肾移植杂志，2021, 30(5): 491-495, 490.
[23]	Folkestad T, Brurberg KG, Nordhuus KM, et al. Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis [J]. Crit Care, 2020, 24(1): 2.
[24]	Pickering JW, Blunt IRH, Than MP. Acute kidney injury and mortality prognosis in acute coronary syndrome patients: a meta-analysis [J]. Nephrology (Carlton), 2018, 23(3): 237-246.
[25]	Ronco C, Bellasi A, Di Lullo L. Implication of acute kidney injury in heart failure [J]. Heart Fail Clin, 2019, 15(4): 463-476.
[26]	王银娜，谌贻璞. 1型心肾综合征的发病机制及肾内科治疗[J]. 中华保健医学杂志，2011, 13(4): 277-280.
[27]	Uber AM, Sutherland SM. Nephrotoxins and nephrotoxic acute kidney injury [J]. Pediatr Nephrol, 2020, 35(10): 1825-1833.
[28]	Bentley ML, Corwin HL, Dasta J. Drug-induced acute kidney injury in the critically ill adult: recognition and prevention strategies [J]. Crit Care Med, 2010, 38(6 Suppl): S169-S174.
[29]	van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis [J]. Crit Care, 2013, 17(3): R98.
[30]	濮雪华，汤梦南，胡海涛，等. 有创通气的急性呼吸窘迫患者发生急性肾损伤的危险因素分析[J]. 中华急诊医学杂志，2021, 30(12): 1489-1493.
[31]	Domenech P, Perez T, Saldarini A, et al. Kidney-lung pathophysiological crosstalk: its characteristics and importance [J]. Int Urol Nephrol, 2017, 49(7): 1211-1215.
[32]	董照刚，郑喜胜，贾明雅，等. 尿NAG、血PCT及SOFA评分对脓毒症患者急性肾损伤的预测价值[J]. 中华医院感染学杂志，2020, 30(23): 3534-3538.
[33]	Gong Y, Ding F, Zhang F, et al. Investigate predictive capacity of in-hospital mortality of four severity score systems on critically ill patients with acute kidney injury [J]. J Investig Med, 2019, 67(8): 1103-1109.
[34]	Wang H, Kang X, Shi Y, et al. SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute kidney injury undergoing continuous renal replacement therapy [J]. Ren Fail, 2020, 42(1): 638-645.
[35]	Lameire NH, Levin A, Kellum JA, et al. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference [J]. Kidney Int, 2021, 100(3): 516-526.
[36]	Abdalrahim MS, Khalil AA, Alramly M, et al. Pre-existing chronic kidney disease and acute kidney injury among critically ill patients [J]. Heart Lung, 2020, 49(5): 626-629.
[37]	史冬梅，项晓刚，王晓琳，等. 慢性肝病住院患者急性肾损伤的发病及预后相关因素分析[J]. 肝脏，2017, 22(3): 200-204.
[38]	叶程军，吴国红，祝国宁. 慢性乙型肝炎急性肾损伤(AKI)患者的发病及预后分析——评《实用慢性肝炎诊治重点》[J]. 中国实验方剂学杂志，2022, 28(14): 43.
[39]	Kale A, Sankrityayan H, Gaikwad AB. Epigenetic restoration of endogenous Klotho expression alleviates acute kidney injury-diabetes comorbidity [J]. Life Sci, 2022, 288: 120194.
[40]	Heung M, Koyner JL. Entanglement of sepsis, chronic kidney disease, and other comorbidities in patients who develop acute kidney injury [J]. Semin Nephrol, 2015, 35(1): 23-37.

危险因素	机制
高龄	肾脏结构和功能改变；多病共存；联合使用多个药物
脓毒症	免疫炎症反应；凝血级联激活；细胞凋亡；线粒体功能异常
外伤
外科手术	肾脏缺血-再灌注损伤；RAAS系统活化；炎症
创伤	肾脏灌注不足；横纹肌溶解；炎症；直接肾脏损伤；腹腔间隔室综合征
烧伤	全身炎症反应
心力衰竭	肾脏血流减少；CVP增高；神经激素激活
肾毒素	对肾脏造成多重损伤
机械通气	肾脏灌注不足；影响神经体液系统
APACHEⅡ、SOFA评分高	多器官组织损伤
慢性病史
慢性肾脏病史	肾功能减退；肾脏对损伤易感性增加
慢性肝病史	消化道出血；RAAS系统活化
糖尿病	肾动脉病变；肾脏缺血
高血压	肾单位减少；肾动脉硬化；肾脏缺血

危险因素	机制
高龄	肾脏结构和功能改变；多病共存；联合使用多个药物
脓毒症	免疫炎症反应；凝血级联激活；细胞凋亡；线粒体功能异常
外伤
外科手术	肾脏缺血-再灌注损伤；RAAS系统活化；炎症
创伤	肾脏灌注不足；横纹肌溶解；炎症；直接肾脏损伤；腹腔间隔室综合征
烧伤	全身炎症反应
心力衰竭	肾脏血流减少；CVP增高；神经激素激活
肾毒素	对肾脏造成多重损伤
机械通气	肾脏灌注不足；影响神经体液系统
APACHEⅡ、SOFA评分高	多器官组织损伤
慢性病史
慢性肾脏病史	肾功能减退；肾脏对损伤易感性增加
慢性肝病史	消化道出血；RAAS系统活化
糖尿病	肾动脉病变；肾脏缺血
高血压	肾单位减少；肾动脉硬化；肾脏缺血

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