Comparison of clinical characteristics of acute kidney injury versus acute-on-chronic renal failure: Our experience in a developing country

SummaryBackgroundFrom developing countries, there is paucity of information regarding epidemiological characteristics of acute-on-chronic renal failure (ACRF) that differs from acute kidney injury (AKI).MethodsIn this prospective study, we analyzed and compared clinical characteristics and outcome of ACRF with AKI from January 2007 to August 2012.ResultsA total of 1117 patients with community-acquired AKI were included in study (AKI = 835; ACRF = 282). Patients with ACRF were older than patients with AKI (p < 0.001). Sepsis was the main cause of acute decline in renal functions in patients with ACRF in comparison to AKI (p < 0.001). Volume depletion/renal hypoperfusion was the most common cause of AKI and the difference was statistically significant as compared to ACRF (33.9% vs. 17.7%; p < 0.001). Need for dialysis was significantly less in patients with ACRF as compared to AKI (68% vs. 77.4%; p 0.002). Lower inhospital mortality was observed in ACRF in comparison to AKI (5% vs. 8.9%, p = 0.04), while no significant difference was noted in terms of duration of hospital stay between the two groups (p = 0.67). However, a significantly higher proportion of patients with ACRF did not recover and progressed to end-stage renal disease as compared to AKI (20% vs. 7.8%; p < 0.001).ConclusionACRF constituted an important cause (25%) of AKI. An episode of superimposed AKI is associated with significantly increased risk of progression to end-stage renal disease in patients with chronic kidney disease.背景慢性腎病合併急性腎衰竭 (ACRF) 不同於急性腎損傷 (AKI)，然而在發展中國家，ACRF 的流行病學數據仍然相當有限。方法在 2007 年 1 月至 2012 年 8 月期間，我們進行了一項前瞻性研究，分析並比較了 ACRF 與 AKI 的臨床特徵和治療後果。結果研究對象為 1117 位社區性 AKI 患者 (AKI = 835；ACRF = 282)，其中 ACRF 患者較 AKI 患者年老 (p < 0.001)。相比於 AKI，ACRF 的急性腎功能下降較常歸因於敗血症 (p < 0.001)；相比於 ACRF，AKI 則較常歸因於容積匱乏/腎灌流不足 (33.9% vs. 17.7%；p < 0.001)；ACRF 患者比 AKI 患者較少需要接受透析療法 (68% vs. 77.4%；p = 0.002)；ACRF 患者的院內死亡率低於 AKI 患者 (5% vs. 8.9%；p = 0.04)，兩組間的住院期則無明顯差別 (p = 0.67)；然而，相比於 AKI 患者，明顯較多的 ACRF 患者無法康復並惡化成末期腎病 (ESRD) (20% vs. 7.8%；p < 0.001)。結論慢性腎病合併急性腎衰竭是急性腎損傷的重要病因 (25%)；在慢性腎病患者間，AKI 的發生明顯增加惡化為 ESRD 的風險。