The long-term consequences of postoperative acute kidney injury

术后急性肾损伤的长期后果

• 批准号: 7305869
• 负责人: Areef Ishani
• 金额: $ 7.23万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-07 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7305869
• 关键词: Accounting; Acute Renal Failure with Renal Papillary Necrosis; African American; Age; Angiotensins; Area; Blood Glucose; Cardiovascular Diseases; Caucasoid Race; Cessation of life; Characteristics; Chronic Kidney Failure; Clinical Trials; Cohort Studies; Communities; Complex; Congestive Heart Failure; Creatinine; Data; Data Set; Data Sources; Day Surgery; Deterioration; Development; Diabetes Mellitus; Diuretics; End stage renal failure; Epidemiologic Methods; Event; Frequencies; Future; Glomerular Filtration Rate; Goals; Healthcare Systems; Hemoglobin; Hospitalization; Incidence; Individual; Intervention; Kidney; Kidney Diseases; Knowledge; Laboratories; Length of Stay; Long-Term Effects; Measures; Methodology; Morbidity - disease rate; Myocardial Infarction; Numbers; Operative Surgical Procedures; Outcome; Patients; Peripheral Vascular Diseases; Pharmaceutical Preparations; Pharmacy facility; Physiological; Population; Postoperative Period; Prevalence; Rate; Recording of previous events; Recovery; Renal function; Renin; Research; Risk; Risk Factors; Sample Size; Serum; Severities; Stroke; Subgroup; Testing; Time; Training; United States Department of Veterans Affairs; Work; base; burden of illness; cohort; cost; day; experience; follow-up; improved; innovation; modifiable risk; mortality; novel; prevent; programs; prospective

DESCRIPTION (provided by applicant): Acute kidney injury (AKI) is a common event, especially among individuals undergoing surgery. Short-term complications of AKI are well defined and included, an increased hospital length of stay, an increased cost of hospitalization, and increased risk of short- term mortality. There exists a gap in knowledge regarding the long-term consequences of AKI. Specifically, it remains unknown if AKI episodes contribute to the burden of chronic kidney disease or long-term mortality. As an outcome of the proposed project we aim to determine whether postoperative AKI is a modifiable risk factor for the development or progression of chronic kidney disease or long-term mortality. This application outlines the use of several nation-wide datasets to efficiently determine the impact of varying levels of postoperative AKI on long-term complications. Available data include prospective peri-operative data, longitudinal laboratory, pharmacy and administrative data. Our specific aims are as follows: To determine if postoperative acute kidney injury is subsequently associated with a) loss of kidney function 90 days after surgery and b) an increased rate of decline of long-term renal function; to determine whether severity of postoperative acute kidney injury is associated with end stage kidney disease (ESKD) and/or long-term mortality; and to determine if the rate of decline of kidney function or risk of ESKD and/or long-term mortality associated with postoperative acute kidney injury is consistent across risk subgroups defined by select patient characteristics. Sample size estimates reveal adequate power for each of the aims. We hypothesize that a greater severity of postoperative AKI will be associated with a lower GFR 90 days postoperatively, a greater slope of GFR loss longitudinally and an increased risk of both ESKD and long-term mortality. We are uniquely suited to this application, as we have access to national surgical, lab and administrative data and our group includes a number of individuals with extensive experience in merging and analyzing large complex datasets for identifying novel determinants of chronic kidney disease and mortality. The objective of this application is to determine the impact of postoperative acute kidney injury on chronic kidney disease and survival. Ultimately, if AKI episodes contribute to long-term renal outcomes and/or survival, therapies maybe developed to enhance recovery of AKI, potentially decreasing the burden of chronic kidney disease or improving long-term survival. The proposed cohort will be the largest assembled to determine the long-term consequences of postoperative AKI. Utilizing the methodology proposed, we will be able to determine in an efficient, cost-effective manner if postoperative AKI and its severity is independently associated in a graded manner with a reduction of kidney function 90 days after surgery, with an increased rate of decline of kidney function over 3 years of follow-up, an increased incidence of ESKD and/or an increased risk of long-term mortality. The research proposed is meaningful because demonstrating that episodes of AKI are associated with long-term outcomes has the potential to identify novel interventions to reduce the burden of CKD in the community. Once the AKI- associated burden of CKD has been precisely estimated and modifiable factors have been identified, clinical trials can be performed that may reduce this disease burden.

描述（由申请人提供）：急性肾脏损伤（AKI）是一个常见事件，尤其是在接受手术的人中。 AKI的短期并发症的定义良好，包括住院时间增加，住院成本增加以及短期死亡率的风险增加。关于AKI的长期后果的知识存在差距。具体而言，AKI发作是否导致慢性肾脏疾病或长期死亡的负担仍然不清楚。作为拟议项目的结果，我们旨在确定术后AKI是否是慢性肾脏疾病或长期死亡率发展或发展的可修改风险因素。该应用程序概述了使用多个全国性数据集的使用来有效确定术后AKI水平的影响对长期并发症的影响。可用的数据包括前瞻性围手术数据，纵向实验室，药房和行政数据。我们的具体目的如下：确定术后急性肾脏损伤随后与a）手术后90天的肾功能丧失以及b）长期肾功能的下降率增加；确定术后急性肾脏损伤的严重程度是否与末期肾脏疾病（ESKD）和/或长期死亡有关；并确定肾脏功能的下降率或ESKD的风险和/或与术后急性肾脏损伤相关的长期死亡率是在某些患者特征定义的风险亚组中保持一致的。样本量估计值揭示了每个目标的足够功率。我们假设术后AKI的严重程度较高，术后90天将与GFR较低，GFR的斜率更大，而ESKD和长期死亡率的风险也会增加。我们非常适合此应用程序，因为我们可以访问国家外科手术，实验室和行政数据，而我们的小组包括许多在合并和分析大型复杂数据集方面具有丰富经验的人，以识别慢性肾脏疾病和死亡率的新决定性因素。该应用的目的是确定术后急性肾脏损伤对慢性肾脏疾病和生存的影响。最终，如果AKI发作有助于长期肾脏结局和/或生存，则可能开发出疗法来增强AKI的恢复，从而减轻慢性肾脏疾病的负担或改善长期生存。拟议的队列将是确定术后AKI的长期后果的最大组装。使用提出的方法，如果术后AKI及其严重程度以分级的方式与肾脏功能降低相关，而肾脏功能在手术后90天降低，则肾脏功能下降率增加了3年的随访，ESKD的随访率增加，ESKD和/或长期的长期风险增加。提出的研究是有意义的，因为证明AKI的发作与长期结局有关，有可能确定新颖的干预措施，以减轻社区中CKD的负担。一旦精确地估计了CKD的相关负担并确定了可修改的因素，就可以进行临床试验，以减轻这种疾病负担。