中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (07): 477-481.doi: 10.3969/j.issn.1671-4091.2017.07.011

• 临床研究 • 上一篇    下一篇

华南农村低收入地区慢性肾脏病和急性肾损伤的挑战

张裕生1,吴燕华2,李志莲2,曾鹏飞1,欧琼3,董伟2,陈源汉2梁馨苓2   

  1. 1. 五华县人民医院内二科
    2. 广东省人民医院肾内科（广东省医学科学院）
    3. 广东省人民医院呼吸科（广东省医学科学院），广东省老年医学研究所
  • 收稿日期:2017-02-17 修回日期:2017-05-31 出版日期:2017-07-12 发布日期:2017-07-14
  • 通讯作者: 陈源汉,梁馨苓 johnchen76@126.com，xinlingliang_ggh@163.com E-mail:xinlingliang_ggh@163.com
  • 基金资助:

    国家临床重点专科建设项目，广东省卫计委适宜推广项目广东省自然科学基金项目(2016A030313767)，广州市科技产学研协同创新重大专项(201604020037)

The challenge of chronic kidney disease and acute kidney injury in a low income rural region in Southern China

  • Received:2017-02-17 Revised:2017-05-31 Online:2017-07-12 Published:2017-07-14

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摘要： 目的对华南农村低收入地区的慢性肾脏病(chronic kidney disease,CKD)和急性肾损伤(acute kidney injury, AKI)进行现况调查。方法对广东省某代表性特困农业县的县人民医院的电子医疗信息进行数据挖掘。根据住院期间最低血肌酐来估算肾小球滤过率。用估算的肾小球滤过率判断CKD 并分级。按KDIGO 标准，根据血肌酐变化情况判断AKI 并分级。结果5345 例用于CKD 流行病学分析，其中37.437%合并CKD，3～5 期的比例分别为31.993%、2.806%和2.601%。5 期CKD 患者主要集中在包含肾脏病单元的内科。3～4 期CKD 在内科、外科和其它科室的发生率分别为43.093%、24.783%和19.808% (χ2=430.0，P＜0.001)，在20～39 岁、40～59 岁、60～79 岁和≥80 岁年龄段分别为2.498% 、13.794%、41.402%和65.207%(χ2=1309.5，P＜0.001)。用于AKI 分析的5 158 例患者中，9.442%符合KDIGO-AKI 标准，社区和医院获得性AKI 各占5.428%和4.013%，27.721%AKI 为2～3 级。AKI 在不同科室间的发生率类似，但随着年龄段增大其发生率逐渐增加。根据出院诊断编码，AKI 的诊断率只有7.004%。结论CKD 和AKI 在华南农村低收入地区的发生率高，而重视度不高。提高基层综合防治肾脏病能力将
是一个重大挑战。

关键词: 慢性肾脏病, 急性肾损伤, 农村低收入地区, 流行病学, 数据挖掘

Abstract: Objectives To investigate the epidemiological status of chronic kidney disease (CKD) and acute kidney injury (AKI) in a low income rural region in Southern China. Methods Electronic medical records were retrospectively studied in a representative county-level hospital in Guangdong province. CKD was classified and staged by the estimated glomerular filtration rate according to the lowest blood creatinine level, and AKI was diagnosed and graded by the KDIGO criteria. Results In the 5 345 cases for CKD evaluation, 37.437% cases were complicated with CKD. The percentages of CKD stage 3, 4 and 5 were 31.993%, 2.806% and 2.601%, respectively. Most of the patients with stage 5 CKD were treated in the division of nephrology attached to internal medicine department. CKD incidence was 43.093%, 24.783% and 19.808% (χ2=430.0, P＜0.001) in the internal medicine department, the surgical department, and other departments, respectively. The percentages of CKD at the age of 20～39, 40～59, 60～79 and 80 years and older were 2.498%, 13.794%, 41.402% and 65.207% (χ2=1309.5, P＜0.001), respectively. In the 5 158 patients for AKI analyses, 9.442% were in accordance with the KDIGO-AKI criteria; the community- and hospital-acquired AKI were 5.428% and 4.013%, respectively; the percentages of stage 2 and 3 AKI were 27.721%. The incidence of AKI among different department was similar. However, the incidence of AKI increased with age. The diagnosed AKI patients were only 7.004% according to diagnostic code at discharge. Conclusion The incidence of CKD and AKI is high, but this situation is largely ignored in the low income rural region in Southern China. This is a big challenge to the prevention and therapy system of renal diseases in county-level areas.

Key words: Chronic kidney disease, Acute kidney injury, Rural low income region, Epidemiology, Data mining