影响急性肾功能衰竭患者住院病死率与肾脏预后的危险因素分析

目的：探讨影响急性肾功能衰竭（ARF）住院患者病死率与肾脏预后的危险因素,以提高ARF的治疗水平。方法：通过对我院近10年422例ARF患者临床资料的回顾性研究,应用二值多元Logistic回归和线性回归分析对影响ARF患者病死率与肾脏预后的危险因素进行分析。结果：在32项观察因素中发现低血压、昏迷、消化道出血、呼吸衰竭、肝衰竭、心力衰竭、肿瘤、败血症是患者病死率相关的危险因素;肿瘤、呼吸衰竭、心力衰竭为影响肾功能恢复的危险因素。结论：上述危险因素是影响ARF患者病死率、导致肾功能难以恢复的原因,并与患者的近期预后密切相关。     

急性肾衰竭预后及其影响因素的研究

目的探讨急性肾衰竭（ARF）预后及影响因素。方法回顾性分析1998年1月至2006年12月收治的398例ARF患者的临床资料，根据患者的病因、年龄、有无基础疾病、是否行肾脏替代治疗、是否合并多脏器功能衰竭分析ARF的预后。结果并发严重心脑血管疾病、严重感染、恶性肿瘤者预后较差；有基础疾病、老年、未行肾脏替代治疗、合并其他脏器功能衰竭者预后差，与对照组比较，差异有统计学意义（P〈0．05）。结论ARF的预后受多种因素的影响，临床医师应予以充分透析治疗，防治并发症，以改善预后。     

410例急性肾衰竭患者临床特点及影响预后的危险因素分析

目的：总结急性肾衰竭（ARF）的病因、临床特点以及影响预后的因素。方法：回顾性分析收治的410例ARF患者的临床资料及病因、病史与血常规、尿常规、肾功能、电解质、血蛋白、血气分析等影响预后因素。结果：410例ARF患者中,男275例,女135例。男∶女=2.04∶1,平均年龄（48.15±18.33）岁。ARF病因：少年组以急性肾小球肾炎等肾实质性疾病为主,中年组为急性肾衰竭发病年龄高峰,以梗阻性肾病为主,其次为肾实质性病和肝胆胰疾病。老年组病因主要见于肾病,治愈率最低（26.83%）,病死率最高（13.82%）,明显高于青年组（10.92%）和中年组（4.83%）,差异有统计学意义。单因素分析显示有无肾病史、MODS、血K^＋、Hb、HCT、Alb共6个因素是影响预后的因素。多因素Logistic回归分析显示,低血红蛋白、MODS、高血钾是影响病死率的危险因素。结论：肾后性原因导致的ARF需要引起关注。积极治疗原发病因,同时重视增加病死率危险因素纠正,尤其是MODS有助于降低ARF病死率。     

云南地区116例急性肾功能衰竭的临床分析

目的 探讨急性肾功能衰竭(Acute renal failure ARF)的发病情况、病因及死亡原因,以提高急性肾衰竭(ARF)的诊治水平.方法 回顾性分析116例ARF的临床资料,探讨其发病情况、病因与预后关系等.方法 116例ARF病例,肾前性、肾性、肾后性ARF分别占50.00%、39.66%、10.34%.死亡6例,总病死率为5.17%,其中肾前性因素所致ARF病死率占66.67%,明显高于肾性、肾后性因素所致ARF(p<0.05).结论 引起ARF的病因以肾前性因素为主,肾前性ARF病死率最高,积极治疗原发病的同时,若明确ARF病因和死亡原因,早期充分血液净化、对症支持治疗可改善ARF预后,降低病死率.     

败血症并发急性肾功能衰竭患者的临床特点和影响预后的因素

目的：探讨败血症伴急性肾功能衰竭（ARF）患者的临床特点和影响预后的因素。方法：回顾分析近10年败血症ARF患者的临床资料，分别计算APACHE Ⅱ和ATN－ISI积分，并与非败血症ARF进行对比，运用多因素回归分析观察由败血症引起ARF的临床和主要生化指标与预后的关系。结果：败血症并发ARF者66例，占同期ARF患者的15．6％。多脏器衰竭发生率为87．9％，病死率高达69．7％。单因素分析发现外科原因的败血症、并发呼吸衰竭、肝功能衰竭、辅助呼吸、少尿、昏迷、多脏器衰竭、在ICU中出现ARF以及慢性疾病数目为影响其预后的因素。多因素logistic回归分析结果显示少尿、在ICU中出现的ARF、慢性疾病数目和多脏器衰竭为其独立危险因素。结论：败血症所致ARF患者预后差，其高病死率与少尿，在ICU中出现ARF、合并慢性疾病数目和多脏器衰竭有关。     

慢性肾脏疾病急性加重及其肾功能好转的相关因素分析

目的 探讨慢性肾脏疾病（chronic kidney disease,CKD）急性加重（acute on chronic kidney disease,A/C）的相关因素及其预后并加以分析.方法 对2011年1月至2012年2月住院的A/C患者55例,按其基础疾病、加重因素、好转因素、治疗方式和预后进行回顾性总结.结果 A/C基础疾病以肾病综合征（27.3％）、慢性间质性肾炎（14.5％）、糖尿病肾病（14.5％）、高血压性肾病（10.9％）为主.A/C加重因素依次为感染（32.7％）、原发病加重（29.1％）、肾毒性药物（12.7％）、不规则使用激素及免疫抑制剂（5.5％）等,7例同时存在≥2种病因（12.7％）.积极行透析及非透析治疗后住院期间肾功能好转者38例.随访时间7.6＆#177;4.4个月,其中随访44例,失访11例.随访期间肾功能正常或明显好转患者14例（31.8％）、肌酐倍增患者14例（31.8％）、终末期肾功能衰竭患者8例（18.2％）、死亡患者8例（18.2％）,死亡原因主要为多脏器功能衰竭,其中5例为老年患者.结论 对于A/C加重因素多可逆,但远期预后不佳,应重视A/C发生的加重因素并及早发现,争取在最大程度改善肾功能,降低病死率,延长患者生命.     

老年急性肾衰竭63例临床分析

由于人口的老龄化，老年急性肾衰竭（ARF）发病率明显增加，且病因复杂，病情严重，病死率高。我们总结了我院2000年1月-2006年12月住院的63例老年ARF患者的临床资料，并与同期住院的46例青年ARF患者进行对比分析，探讨老年ARF的临床特点以便提高临床诊治水平及改善预后。     

脓毒症的急性肾损伤

脓毒症是危重病患者的常见病因或并发症，也是大家熟知的引起急性肾损伤（AKI）和多脏器功能障碍综合征（MODS）的常见危险因素。急性肾功能衰竭（ARF）发生率在一般脓毒症患者约为19％；在重度脓毒症约为23％；在血培养阳性的脓毒症休克者可高达51％。ARF并发脓毒症的病死率高达70％，明显高于无并发脓毒症的45％。因此，研究并了解AKI和脓毒症的相互关系和作用机制，将有助于降低脓毒症时AKI的高发病率以及相关的高器官衰竭率和病死率。     

急性心肾综合征的血液净化治疗

肾功能异常是心力衰竭患者常见的并发症,使心力衰竭治疗更加困难,使患者预后更加凶险,肾小球滤过率（GFR）每降低10%,患者病死率升高7％,即使血肌酐一过性升高（超过基础值的25％）也会增加患者住院天数和病死率。美国急性失代偿性心力衰竭国家登记（ADHERE）资料显示,因急性失代偿性心力衰竭（ADHF）住院的患者中-重度肾功能不全（GFR〈60ml／min）很常见,相反,肾功能正常的患者很少见。老年人、基础肾功能不全、合并糖尿病、高血压控制欠佳、使用抗炎药物和血管紧张素转换酶抑制剂（ACEI）等药物的心力衰竭患者更容易出现肾功能下降。     

重型肝炎肝移植术后急性肾功能衰竭的防治

目的 总结重型肝炎肝移植术后急性肾功能衰竭（ARF）的防治经验。方法 回顾性分析2002年9月至2004年10月上海交通大学医学院附属瑞金医院因重型肝炎行肝移植治疗的37例病人的临床资料。结果 37例病人术后1年移植物存活率为83.8％，围手术期死亡6例（16．2％），术后并发ARF12例（32．4％），ARF组与非ARF组术前血总胆红素、肌酐、腹水量、凝血酶原时间比较，差异有显著性意义；两组术中出血量、血制品输入量、无肝期、手术时间比较，差异亦有显著性意义。结论 重型肝炎肝移植术后ARF诱发因素众多，多数病人经过综合治疗后肾功能能够得到恢复，必要时可选择连续性肾替代治疗（CRRT）。     

Acute Renal Failure in Hospitalized Patients in China: A Prospective Study

Acute renal failure (ARF) is a common complication in hospitalized patients, but little is known about the epidemiology of ARF in China. In this study, we performed a prospective examination of the cause, prognosis, and risk factors associated with ARF at a hospital in Shanghai, China. We considered all ARF patients who were admitted to our hospital from December 2003 to December 2006. Among the 320 ARF patients, 135 (42.2%) were over the age of 60. Sepsis, heart failure, and nephrotoxic drug use were the leading causes of ARF. The overall mortality rate was 31.9%, and mortality rate was significantly higher among the elderly. Logistic regression indicated that heart failure, respiratory failure, and malignant cancer were risk factors independently associated with poor prognosis. In this Shanghai hospital, there was a high incidence and mortality rate of patients hospitalized with ARF. The prognosis of patients who underwent renal replacement therapy was better than those who were treated more conservatively.     

Acute Renal Failure Complicating Severe Acute Pancreatitis

The records of 563 patients admitted to the hospital with diagnosis of acute pancreatitis have been studied retrospectively. The aim of the study was to investigate the prevalence of acute renal failure (ARF) in these patients, and to evaluate the most important risk factors for ARF development and mortality. The prevalence of ARF in studied population was 14%, but only 3.8% of ARF patients with acute pancreatitis had isolated renal failure. Other patients had additional failure of other organ systems, 68.4% of whom had multiorgan failure (MOF) before the onset of ARF. In only 8.9% of ARF patients was the renal system the first organ system to fail. Patients with ARF were significantly older, had more preexisting chronic diseases (including chronic renal failure), usually had MOF, and local pancreatic complications relative to these in the group with normal renal function. The development of ARF was directly influenced by severity of acute pancreatitis. The mortality rate in ARF patients was 74.7%, compared to an 7.4% mortality of patients with acute pancreatitis and normal renal function. Preexisting chronic disease, the presence of MOF and their number, local pancreatic complications, and older age of the patients increased mortality in ARF patients. The prognosis of patients with oliguric ARF requiring renal replacement therapy was extremely poor, indicating the importance of prevention of ARF in the patients with acute pancreatitis.     

240例急性肾损伤的临床分析

目的 回顾性分析急性肾损伤(AKI)的病因、病理、治疗及预后,探讨AKI的病因特点、预后影响因素.方法 收集我院的240例AKI患者的临床资料进行整理分析.结果 240例AKI患者中,肾前性AKI患者90例(占37.5%),主要病因为心功能不全、感染、体液丢失等;肾性AKI患者127例(占52.9%),主要致病因素为药...     

肝移植病人术后急性肾功能衰竭18例临床分析

目的:探讨影响肝移植术后发生急性肾功能衰竭的原因及处理方法。方法:回顾性分析我院91例肝移植病人中发生与未发生术后急性肾功能衰竭病人的临床资料,采用单因素分析和Logistic回归模型进行多因素分析。结果:肾衰组病人1年生存率低于对照组;与术后发生早期急性肾功能衰竭的有关因素包括术前血清肌酐、总胆红素、总手术时间、术中出血量、输血量、术中输液总量、术中尿量。术前血清肌酐高和术中尿量是术后早期急性肾功能衰竭发生的独立影响因素。移植术后发生急性肾功能衰竭的病人ICU留置时间延长,术后住院时间延长,住院费用升高。结论:肝移植术后有较高的急性肾功能衰竭发生率,对术后少尿、血清肌酐水平升高的病人及早实施肾脏替代等治疗能有效降低其发病率和死亡率。     

Acute renal failure requiring renal replacement therapy after orthotopic liver transplantation

OBJECTIVES: Acute renal failure (ARF) is a severe complication in patients undergoing orthotopic liver transplantation (OLT), which predicts a poor outcome. The aim of this study was to analyze risk factors for the development of ARF, including severity of illness, onset time of ARF prognostic factors of outcome, and mortality in a group of critically patients requiring renal replacement therapy (RRT). METHODS: Retrospective analysis of 240 consecutive liver transplant cases from 1999 to 2001 admitted to the intensive care unit (ICU) was performed to identify risk factors for ARF development after OLT. The analyzed factors were: age, sex, CrS, BUN, diuresis, sepsis, hypovolemia, cardiac failure, nephrotoxic drugs (cyclosporine or FK506, antibiotics), hyperbilirubinemia, associated diseases (DM, CRF), onset time of renal failure and progressiveness, timing of RRT, number of days of RRT, and mortality. We examined variables upon admission to the ICU, before the first RRT, and on the last ICU day before resignation or death. We used Students' t test. Quantitative parameters were expressed as mean values +/- SD. RESULTS: Of the 240 patients, 20 (8.3%) experienced ARF needing renal replacement therapy during the postoperative period. The results of our study suggested that ARF among patients undergoing RRT conferred an excessive risk of in-hospital death: eight patients died (40%). This increased risk cannot be explained solely by a more pronounced severity of illness. CONCLUSION: Our results provide strong evidence that ARF presents a specific, independent risk factor for a poor prognosis.     

Acute renal failure and renal replacement therapy in the postoperative period of orthotopic liver transplant patients versus nonelective abdominal surgery patients

Acute renal failure (ARF) often complicates the postoperative period of patients undergoing orthotopic liver transplantation (OLT); it is habitually associated with high mortality rates. Similarly, patients undergoing major nonelective abdominal surgery are prone to ARF because of their frequent preexistent morbidities, abdominal sepsis, and needed for extended surgical procedures. The aim of this study was to evaluate the incidence of ARF and use of renal replacement therapy (RRT) among OLT versus nonelective abdominal surgery patients and associations with clinical outcomes. We studied all the patients admitted to a surgical intensive care unit (ICU) from January 2008 to December 2009 after OLT or nonelective abdominal surgery. The inclusion criteria were an ICU stay of at least 48 hours and without prior end-stage renal failure. OLT patients (n = 84) were younger and less severly ill than surgery patients (n = 60). ARF occurrence was lower among the OLT (29%) than the surgery group (47%) requiring RRT in 71% and 53% of patients due to ARF, respectively. The ICU mortality of ARF patients in both groups (29% OLT and 51% surgery) were greater than among subjects without ARF (2% and 6%). The occurrence of ARF is common among these two patient groups, and associated with increased risk of death among in surgery (+45%) versus in OLT (+27%) patients.     

Retrospective analysis on Chinese patients diagnosed with acute renal failure hospitalized during the last decade (1994-2003)

OBJECTIVES: To investigate the epidemiology, diagnosis and prognosis of acute renal failure (ARF) in hospitalized Chinese during the last decade. METHODS: The diagnosis of patients with ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and the data of epidemiology, etiology and prognosis were analyzed. RESULTS: Only 209 discharged cases were diagnosed with ARF and all were reconfirmed. Two peak occurrences were found at ages of 35-45 and 60-80 with a male predominance of approximately 59.7%. Patients diagnosed with ARF accounted for 1.19 per thousand of the admissions in the same period and increased significantly in the last 5 years (p = 0.038). The creatinine level at diagnosis was 345.8 +/- 122.6 micromol/l and had no significant change (p > 0.05). The percent of hospital-acquired ARF (HA-ARF) demonstrated a significant increase in 1999-2003 compared to 1994-1998 (p = 0.008). Intrarenal ARF accounted for 73.69% and was multifactorial, with drugs, infections and operations as leading causes. Renal biopsy was performed in 37.32% (78/209) with 53.84% (42/78) having acute interstitial nephritis. Maintenance dialysis was discontinued in 46.41% because their renal function completely or partially recovered. The overall mortality was 37.91% without improvement over time. The mortality was 6.25% for patients in nephrology department, but 65.51% in ICU (p < 0.001), and was 21.6% for patients in community-acquired ARF (CA-ARF), but 63.1% in HA-ARF (p < 0.001). CONCLUSIONS: During the past 10 years, the number of patients diagnosed with ARF has been rising in hospitalized Chinese. HA-ARF was the major source, and infections, drugs and operations were the leading causes. The diagnosis and prognosis of acute renal failure did not improve much in this population over the decade studied.     

Effect of acute renal failure on outcome in children with severe septic shock

Acute renal failure (ARF) requiring renal replacement therapy (RRT) has been associated with an excess risk of mortality in adult patients with septic shock, but it is unknown whether this is also applicable to pediatric patients. We therefore conducted a retrospective pilot study. All children presenting with septic shock between 1st January 1998 and 1st April 2004 were analyzed. Patients with fluid refractory-dopamine resistant shock, necessitating the use of noradrenaline, were included. ARF was defined as the deterioration of renal function to the extent that renal replacement therapy was required (ARF group). This ARF group was compared with patients without ARF (non-ARF group). Out of the 22 children with severe septic shock, seven developed ARF. PIM2 and PRISM scores upon admission were comparable between both groups. Mortality rates were significantly higher in patients with ARF (57.1% vs 6.7%; p=0.02). Pediatric patients with severe septic shock developing ARF have excess mortality compared to pediatric patients who do not develop ARF, although on diagnosis, severity of underlying disease and calculated risk of mortality were comparable. A multicenter trial is necessary to confirm these findings and to determine the contribution of ARF to pediatric sepsis mortality.     

A Simple and Early Prognostic Index for Acute Renal Failure Patients Requiring Renal Replacement Therapy

Recent advances in technology have not substantially changed the high mortality rate associated with acute renal failure (ARF). To obtain a simple, valid prognostic index, we retrospectively evaluated the relative importance of demographic data, causes (acute insults) of renal failure, and comorbid clinical conditions for the outcome in 102 ARF patients who received renal replacement therapy with an overall mortality rate of 65% (66 of 102). There were no significant differences between survivors and nonsurvivors in age and gender. Mortality according to acute insults was similar to that of the whole population studied. Of the 10 clinical conditions at the time of the first renal replacement therapy, mechanical ventilation (p = 0.0002), cardiac failure (p = 0.0006), hepatic failure (p = 0.003), central nervous system dysfunction (p = 0.005), and oliguria (p = 0.04) were found to be significantly related to mortality by univariate analysis. Furthermore, multivariate analysis demonstrated that only mechanical ventilation, cardiac failure, and hepatic failure were significant risk factors. Survival was directly related to the number of significant variables in univariate analysis: zero, 89% (8 of 9); one, 62% (21 of 34); two, 19% (5 of 27); three, 10% (2 of 20); four, 0% (0 of 8); five, 0% (0 of 4). This simple and early prognostic index, derived from the assessment of clinical conditions which were easily de-termined at the patient's bedside, could be useful for outcome prediction in ARF patients requiring renal replacement therapy.