Læknablaðið - 15.11.2013, Blaðsíða 15

RANNSÓKN
landi hafi gengist undir mælingu sem greina megi í gagnagrunni
rannsóknarstofunnar á spítalanum. Því teljum við að rannsóknin
gefi nokkuð góða mynd af nýgengi og tímabilsalgengi á bráðum
nýrnaskaða á Islandi. Að minnsta kosti gefa niðurstöður þessarar
rannsóknar réttari mynd af tíðninni í samfélaginu almennt en nið-
urstöður rannsókna frá háskólasjúkrahúsum erlendis sem bundin
eru við ákveðin landsvæði eða undirhópa sjúklinga.
Af niðurstöðunum má álykta að bráður nýrnaskaði sé alvarlegt
og algengt sjúkdómsástand á Islandi. Sjúklingar með alvarlegan
bráðan nýrnaskaða voru með marga áhættu- og orsakaþætti en
algengastir voru skurðaðgerð, blóðþrýstingsfall tengt hjarta- og
æðakerfi og lyf. Langflestir þessara sjúklinga lögðust inn á spítala
og stór hluti lagðist inn á gjörgæsludeild. Um 11% þurftu blóðskil-
unarmeðferð í legu en innan við 1% þurfti slíka meðferð lengur
en 30 daga. Dánartíðni sjúklinga með alvarlegan bráðan nýrna-
skaða er há.
Þakkir
Við þökkum ísleifi Ólafssyni yfirlækni fyrir aðstoð við öflun
kreatíníngilda og Ingibjörgu Richter kerfisfræðingi á Landspítala
fyrir aðstoð við öflun gagna úr rafrænum kerfum spítalans.
Heimildir
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ENGLISH SUMMARY
Epidemiology of acute kidney injury in a tertiary care university hospital according to the RIFLE criteria
Long ThE1, Sigurdsson Mlz, Indridason OS3, Sigvaldason K2, Sigurdsson GH12
Introduction: Acute kidney injury (AKI) is a common problem in hospi-
talized patients, requiring extensive treatment and carries a high mortal-
ity rate. This study was designed to assess the epidemiology of AKI, and
risk factors and outcome of patients with severe AKI in a tertiary care
university hospital in lceland.
Material and methods: All adult patients with measured serum cre-
atinine (SCr) in Landspitali University Hospital from January 2008 to
December 2011, who had a measured baseline SCr in the preceeding
six months, were included. Patients were categorized according to the
RIFLE-criteria into risk (stage 1), injury (stage 2) and failure (stage 3)
groups based on their highest SCr, using the lowest SCr in the previous
six months as baseline.
Results: A total of 17,693 individuals (out of 74,960) had a baseline SCr
and their data were used for analysis. AKI occured in 3,686 (21 %) with
12%, 5% and 4% of stage 1, 2 and 3, respectively. There were more
females in stage 1 and stage 2 and more males in stage 3 (p< 0.001).
Contributing causes for AKI in patients with stage 3 AKI were surgery
(22%), circulatory shock (23%), sepsis (14%), cardiovascular insult
(32%), respiratory failure (27%), bleeding (10%), trauma (7%) and AKI
associated drugs (61%). Dialysis was required in 11% and in 0.7% for
longer than 30 days but none > 90 days. One year survival was 52%.
Conclusions: Acute kidney injury is common in lceland and the prog-
nosis of those with severe AKI is dismal. Majority of those patients were
taking drugs that increase risk of AKI, providing a target for preventive
measures.
Key words: Acute kidney injury, survival, RIFLE criteria, risk factors, comorbid diseases.
Correspondence: Gísli H. Sigurðsson, gislihs@landspitali.is
'Facuity of Medicine, University of lceland, 2Department of Anesthesia and Intensive Care, 3Division of Nephrology, Landspítali - The National University Hospital of lceland, Reykjavík.
LÆKNAblaðið 2013/99 503