Pavan K Bhatraju, Leila R Zelnick, Ian B Stanaway, T Alp Ikizler, Steven Menez, Vernon M Chinchilli, Steve G Coca, James S Kaufman, Paul L Kimmel, Chirag R Parikh, Alan S Go, Edward D Siew, Mark M Wurfel, Jonathan Himmelfarb
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引用次数: 0
摘要
背景:认知功能障碍是众所周知的慢性肾脏病并发症,但急性肾损伤(AKI)后的幸存者是否会出现认知功能下降却鲜为人知。我们假设急性肾损伤与较差的认知功能有关,至少部分原因是持续的全身炎症:ASSESS-AKI招募了住院三个月后存活的患者,根据人口统计学、并发症和基线肾功能对患者进行了匹配。其中一部分患者在 3 个月、12 个月和 36 个月时接受了改良迷你精神状态检查(3MS)的认知测试。我们使用混合线性模型研究了AKI与3MS评分的关系,并评估了由全身炎症生物标志物介导的风险比例:在参加 ASSESS-AKI 的 1538 名参与者中,有 1420 人(92%)在 3 个月时完成了 3MS 评估,并有相应的匹配参与者。与无 AKI 的参与者相比,有 AKI 的参与者三年后的 3MS 评分较低(差异为-1.1 (95% CI: -2.0, -0.3) P=0.009)。与无 AKI 的参与者相比,有更高比例的 AKI 参与者三年后的 3MS 评分出现了有临床意义的降低(≥ 5 分)(14% 对 10%,P=0.04)。在中介分析中,AKI 后三个月的血浆可溶性肿瘤坏死因子受体-1(sTNFR-1)中介了 35% (P=0.02)与 AKI 相关的三年后 3MS 评分风险:AKI与较低的3MS评分相关,而sTNFR-1浓度似乎在很大程度上介导了长期认知障碍的风险。还需要进一步研究来确定 AKI 是认知障碍的因果关系还是标记物。
期刊介绍:
The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.