Abstract
BackgroundThe epidemiology of acute kidney injury (AKI) in nonexacerbated chronic obstructive pulmonary disease (NECOPD) patients is unknown. This study investigated the factors associated with AKI and the association between AKI and in-hospital mortality in the hospitalized NECOPD population.MethodsThe electronic medical records of 2897 patients hospitalized with NECOPD were analyzed retrospectively. Demographic information, medicine used before AKI, diagnosis records and laboratory data were collected. AKI was classified as community-acquired (CA-) or hospital-acquired (HA-) AKI according to the serum creatinine criteria. Risk factors for HA-AKI and in-hospital mortality were analyzed by logistic regression analyses. To avoid an interaction between cor pulmonale and AKI, the association between AKI and in-hospital morality was further analyzed with cor pulmonale stratification.ResultsThe incidence rates of CA- and HA-AKI were 7.1 and 12.0%, respectively. Increased age, female sex, cor pulmonale comorbidity, chronic kidney disease stage, diuretic and glycopeptide use before AKI and iodine-containing contrast medium exposure were independently associated with HA-AKI. A total of 5.7% of the patients died. After adjustment for age, sex, cor pulmonale, chronic kidney disease, Charlson comorbidity index score (without renal disease) and hemoglobin level, HA-AKI was an independent risk factor for in-hospital mortality [OR 13.909 (95% CI 8.699–22.238) in non-cor pulmonale subgroup; OR 26.604 (95% CI 12.166–58.176) in cor pulmonale subgroup], whereas CA-AKI was not.ConclusionsAKI is common in the NECOPD population. Diuretics and contrast media are associated with HA-AKI in this population. The patients with HA-AKI have a higher mortality risk than the patients without AKI.
Highlights
The epidemiology of acute kidney injury (AKI) in nonexacerbated chronic obstructive pulmonary disease (NECOPD) patients is unknown
We investigated the factors associated with AKI and the association between AKI and inhospital mortality in the hospitalized NECOPD population
Observational indices AKI was diagnosed according to the criteria provided by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines; AKI was confirmed if the SCr value increased by more than 50% compared to the baseline value within 7 days [10]
Summary
The epidemiology of acute kidney injury (AKI) in nonexacerbated chronic obstructive pulmonary disease (NECOPD) patients is unknown. It is a progressive disease that results in a significant burden, both medically and financially. COPD is the third leading cause of death among diseases, resulting in a great economic burdens to society [1]. Acute exacerbations of COPD (AECOPD) require emergent medical care, and their estimated 3-year all-cause mortality rates are as high as 50% in patients who require hospitalization [2]. In addition to urgent therapy for AECOPD, care under stable conditions is essential for COPD patients. It is worth noting that many hospitalized patients admitted to respiratory departments or other units have nonexacerbated COPD (NECOPD). Hypoxemia is an elementary pathophysiological disorder associated with COPD, regardless of acute or stable conditions. Due to the systemic damage of hypoxemia, the recognition of extrapulmonary complications will facilitate effective personal management
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