Acute-on-chronic Kidney Injury Patients:the Clinical Analysis

Objective:To investigate acute worsening of renal function of chronic kidney disease (CKD)(acute-on-chronic kidney injury, ACKI) and analyse the basic information, inducements, treatment preferences, effects and outcomes, looking forward to reduce the morbidity of ACKI. Methods:Data from all patients diagnosed as ACKI for one year period (Jan,2011to Feb,2012) were collected, and the inducements, underlying disease, treatment preferences, effects and outcomes were analysed retrospectively. Results:A total of55patients of ACKI were included in the study, which was5.2%of hospitalized CKD patients in the same period. Nephrotic syndrome, chronic interstitial nephritis and diabetic nephropathy is highly susceptible to ACKI. The common causes were infection (30.9%), aggravation of underlying diseases (29.1%), nephrotoxicity drug (12.7%) respectively. The therapeutically effective patients were38, the actively control of the primary disease (59.5%), effective treatment of infection (10.5%) and stop useing nephrotoxicity drug(2.6%) were the important measures to reverse the renal function. The therapeutically ineffective patients were17, compared to the effective patients, the proprotion of hypertension, hypertensive nephropathy and comorbidities is higher(P<0.05).The follow-up time were7.1±3.8months,29cases of effective patients and15cases of ineffective patients were follow-up respectively, compared with each other, the percentage of the renal function improved is34.2%vs5.9%, P<0.05, doubling of serum creatinine is23.7%vs29.4%, end-stage renal failure(ESRF) is7.9%vs29.4%, P<0.05and the mortality is10.5%vs23.5%. The incidence rate of doubling of serum creatinine between the effective patients and ineffective patients in12months is17%and62%respectively(P<0.05). The hypertension and comorbidities is the risk factors of doubling of serum creatinine. Conclusions:ACKI, especially in patients of nephrotic syndrome, chronic Interstitial nephritis and diabetic nephropathy, will have bad outcomes if the effective treatment is not done promptly. Be aware of the risk factors of ACKI, especially infection, informal therapy and nephrotoxicity drug, is highly urgent.