华南农村低收入地区慢性肾脏病和急性肾损伤的挑战

The challenge of chronic kidney disease and acute kidney injury in a low income rural region in Southern China

目的对华南农村低收入地区的慢性肾脏病(chronic kidney disease,CKD)和急性肾损伤(acute kidney injury,AKI)进行现况调查。方法对广东省某代表性特困农业县的县人民医院的电子医疗信息进行数据挖掘。根据住院期间最低血肌酐来估算肾小球滤过率。用估算的肾小球滤过率判断CKD并分级。按KDIGO标准,根据血肌酐变化情况判断AKI并分级。结果 5345例用于CKD流行病学分析,其中37.437%合并CKD,3~5期的比例分别为31.993%、2.806%和2.601%。5期CKD患者主要集中在包含肾脏病单元的内科。3~4期CKD在内科、外科和其它科室的发生率分别为43.093%、24.783%和19.808%(χ_2=430.0,P<0.001),在20~39岁、40~59岁、60~79岁和≥80岁年龄段分别为2.498%、13.794%、41.402%和65.207%(χ_2=1309.5,P<0.001)。用于AKI分析的5158例患者中,9.442%符合KDIGO-AKI标准,社区和医院获得性AKI各占5.428%和4.013%,27.721%AKI为2~3级。AKI在不同科室间的发生率类似,但随着年龄段增大其发生率逐渐增加。根据出院诊断编码,AKI的诊断率只有7.004%。结论 CKD和AKI在华南农村低收入地区的发生率高,而重视度不高。提高基层综合防治肾脏病能力将是一个重大挑战。

Objectives To investigate the epidemiological status of chronic kidney disease （CKD） and acute kidney injury （AKI） in a low income rural region in Southern China. Methods Electronic medical records were retrospectively studied in a representative county-level hospital in Guangdong province. CKD was classified and staged by the estimated glomernlar filtration rate according to the lowest blood creatinine level, and AKI was diagnosed and graded by the KDIGO criteria. Results In the 5 345 cases for CKD evaluation, 37.437% cases were complicated with CKD. The percentages of CKD stage 3, 4 and 5 were 31.993%, 2.806% and 2.601%, respectively. Most of the patients with stage 5 CKD were treated in the division of nephrology attached to internal medicine department. CKD incidence was 43.093%, 24.783% and 19.808% （χ^2=430.0, P〈 0.001） in the internal medicine department, the surgical department, and other departments, respectively. The percentages of CKD at the age of 20-39, 40-59, 60-79 and 80 years and older were 2.498%, 13.794%, 41.402% and 65.207% （χ^2=1309.5, P〈0.001）, respectively. In the 5 158 patients for AKI analyses, 9.442% were in accordance with the KDIGO-AKI criteria; the community- and hospital-acquired AKI were 5.428% and 4.013%, respectively; the percentages of stage 2 and 3 AKI were 27.721%. The incidence of AKI among different department was similar. However, the incidence of AKI increased with age. The diagnosed AKI patients were only 7.004% according to diagnostic code at discharge. Conclusion The incidence of CKD and AKI is high, but this situation is largely ignored in the low income rural region in Southern China, This is a big challenge to the prevention and therapy system of renal diseases in county-level areas.