Abstract: 【Abstract】Objective To investigate the clinical information, induced factors, therapies, and prognosis in patients with acute renal injury on the basis of chronic kidney disease (CKD) (acute-on-chronic kidney disease, ACKD) in order to reduce morbidity in these patients. Methods Data from ACKD patients during the
period from Jan., 2011 to Feb., 2012 were collected, and their induced factor, underlying disease, therapy and outcome were retrospectively analyzed. Results Fifty-five ACKD patients accounting for 4.6% of hospitalized patients in the same period were included in this study. Nephrotic syndrome, chronic interstitial nephritis and diabetic nephropathy were highly susceptible to ACKD. The common causes inducing ACKD included infection (30.9%), aggravation of underlying diseases (29.1%), and nephrotoxic drug (12.7%). Thirty- eight ACKD patients responded effectively to therapies, and the effective therapies to reverse the renal function included control of the primary diseases (59.5%), treatment of infections (10.5%), and interruption of nephrotoxic drug administration (2.6%). The therapies were ineffective in 17 ACKD patients, in which the prevalence of hypertension, hypertensive nephropathy and its comorbidities were higher than that in effective ACKD patients (P＜0.05). Twenty- nine effective patients and 15 ineffective patients were followed up for 7.1 ± 3.8 months. In the effective patients and ineffective patients, percentage of renal function improvement was 34.2% and 5.9% , respectively (P＜0.05), percentage of doubling serum creatinine level was 23.7% and 29.4%, respectively, percentage of end-stage renal failure was 7.9% and 29.4%, respectively (P＜0.05), and the mortality was 10.5% and 23.5%, respectively. The incidence of doubling serum creatinine in 12 months was 17% and 62% in the effective patients and ineffective patients, respectively (P＜0.05). Hypertension and its comorbidities were the risk factors for doubling serum creatinine level. Conclusions The prognosis of ACKD is poor in patients with nephrotic syndrome, chronic interstitial nephritis and diabetic nephropathy when no effective treatment is administered. The risk factors for ACKD including infections, inappropriate therapies and nephrotoxic drugs should be managed promptly.

Key words: chronic kidney disease, acute-on- chronic kidney disease