老年慢性肾脏疾病并发急性肾损伤的临床特点及危险因素分析

Clinical characteristics and risk factors of acute-on-chronic kidney injury in elderly patients

目的：探讨老年人慢性肾脏疾病（chronic kidney disease,CKD）基础上伴发急性肾损伤（acute-on-chronic kidney injury,ACKI）患者的临床特点及相关危险因素。方法回顾性调查2007年12月至2013年12月间入住我院的60岁以上CKD老年人出现ACKI患者82例的临床资料,对其性别、年龄、基础疾病、诱发因素、急性肾损伤分期及血常规、尿常规、肝功能、肾功能、血糖、血脂、电解质等进行分析及总结其特点,并进行统计学处理。分析 ACKI 相关危险因素。结果82例 ACKI 中,男49例（占59.76%）,女33例（占40.24%）,平均年龄（67.6±5.2）岁,在导致老年 ACKI 的危险因素中,最常见的是高血压急症42例（占51.22%）,其次是严重感染31例（占37.80%）；肾毒性药物及低血容量导致的肾脏灌注不足分别为5例（占6.10%）及4例（占4.88%）,总病死率52.44%（43/82）,男性病死率高于女性（36.59%比15.85%,P〈0.05）；其中高血压急症、严重感染是 ACKI 的独立危险因素,血液净化治疗是保护因素。结论高血压急症、严重感染是ACKI的独立危险因素,严格控制血压、及时控制感染、避免使用肾毒性药物,适时行肾脏替代治疗,是降低老年 ACKI病死率的关键。

Objective To analyze the clinical characteristics and risk factors of acute-on-chronic kidney injury （ACKI）in elderly patients.Methods The clinical data of 82 older patients （over the age of 60）with ACKI hospitalized from December 2007 to December 2013 were studied retrospectively. The gender,age,basic disease,predisposing factors,AKI stage and blood routine,urine routine,liver function,renal function,blood glucose,blood lipid and electrolyte were analyzed.The statistical analysis was performed to identify risk factors associated with ACKI.Results There were 49 males and 33 fe-males with mean age of 67.60±5.20 years.Malignant hypertension was the main risk factor for AC-KI in elderly patients （51.22%,42/82）.The second was severe infections in 31 cases （37.80%）,fol-lowed by nephrotoxic drugs （n=5,6.10%）and hypoglycaemia （n=4,4.88%）.The overall mortality of ACKI was 52.44% （43/82）.The mortality of males was higher than that of femaled （36.59%vs.15.85%,P〈0.05）.Stepwise logistic regression analysis revealed that malignant hypertension and severe infections were the independent risk factors associated with ACKI,while hemopurification was the protective factors.Conclusions Malignant hypertension and severe infections were the independent risk factors associated with ACKI.Strict control of blood pressure,control of all kinds of infection timely,the cautious use of nephrotoxic drugs,and promptly treatment with renal replacement for pre-vention of AKI are the key to reduce the mortality of elderly patient with ACKI.