Kev mob raum mob hnyav: tshwm sim, Aetiology, Kev Tswj Xyuas thiab Cov txiaj ntsig ntsuas ntawm Samoan Case Series

2.3. Kawm tsim thiab sau cov ntaub ntawv

The present study is reported in line with the PROCESS 2020 criteria [10]. This was a single-center prospective observational study. Participants were recruited from the hospital patient information system by the lead investigator, a senior physician specializing in internal medicine. The inclusion criteria for participation were (1) adults (>18 xyoo) tau mus rau hauv pawg ntseeg dav dav ntawm Tupua Tamasee Meaole (TTM) Tsev Kho Mob nrog kuaj mobAKIbetween December 1, 2019 and May 31, 2020, and (2) serum creatinine level of >200 μmol / L, thiab (3) ua raws li tam sim noKab mob raumKev Txhim Kho Ntiaj Teb Cov Tau Txais (KDIGO) cov txheej txheem rauAKI kuaj mob. Cov neeg mob uas muaj kab mob hauv lub raum uas tau ntsib ib ntus ntawm AKI thaum lub sijhawm kawm kuj tau suav nrog hauv txoj kev tshawb no. Cov txheej txheem cais tawm yog (1) cov neeg mob nyob raumob hemodialysis, (2) cov neeg mob hauv qabmob raum mobtsis muaj pov thawj ntawm AKI, thiab (3) cov neeg mob uas nws tsis muaj peev xwm txheeb xyuas qhov kev kuaj mob (piv txwv li, cov neeg mob uas tau nce siabntshav creatinineqhov tshwm sim thiab tsis muaj kev soj ntsuam tom qab hematology). Lub tsev kho mob Laboratory Database tau nkag mus los txheeb xyuas txhua tus neeg mob nkag mus rau TTM Tsev Kho Mob thaum lub sijhawm kawm nrog cov ntshav creatinine ntau dua 200 μmol / L. Qhov no yog siab dua li cov sijhawm siv rau cov qib creatinine ib txwm qhia hauv cov ntaub ntawv (60-110 μmol / L rau cov txiv neej laus, 45-90 μmol / L rau cov poj niam laus) [11]. Qhov kev ntsuas no tau raug xaiv los ua raws li cov qauv siv los ntawm Fijian qhia tsev kho mob uas koom nrog Fiji National University: 200mcmol / L cov qauv qhia txog lawv.AKI triage tswjcov txheej txheem raws li cov ntsiab lus ntawm cov khoom siv tsawg. Txoj kev tshawb fawb tam sim no yog li tau txais tib cov qauv los ntsuas qhov zoo sib xws ntawm cov ntsiab lus qis ntawm Samoa. Tag nrho ntawm 1185 tus neeg mob tau txheeb xyuas, thiab thov kom lawv cov ntaub ntawv kho mob tiav tau ua rau Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob. Txhua cov ntaub ntawv raug tshuaj xyuas rau nws qhov tsim nyog, thiab tag nrho ntawm 1071 cov ntaub ntawv tsis ua raws li cov txheej txheem suav nrog. Qhov piv txwv loj rau txoj kev tshawb fawb tam sim no yog li 114 tus neeg mob. Daim ntawv sau cov ntaub ntawv yog kev hloov pauv ntawm daim ntawv siv los ntawm International Society for Nephrology rau Ntiaj Teb Snapshot Project [12]. Rau txhua tus neeg koom, cov ntaub ntawv hauv qab no tau sau tseg:

YUAV UA LI CAS RAU CISTANCHE ua haujlwm rau cov neeg mob rau lub raum?

2.3.1. Demographic thiab cov yam ntxwv ntawm lub hauv paus

• Cov ntaub ntawv pej xeem: hnub nyoog (xyoo), poj niam txiv neej (txiv neej / poj niam), haiv neeg (Samoan / Lwm yam).

Admission Information: Admitting Department (Medica/Surgical/ Obstetrics&Gynecology), risk factors for AKI (age>75 xyoo / Mob ntshav qab zib mellitus / Kab mob siab ntev / Mob plawv tsis ua hauj lwm / Mob raum mob / mob ntshav qab zib (Hb < 9 g / dL) / tsis muaj / tsis paub), AKI nrhiav tau (cov zej zog / tsev kho mob), lub hauv paus serum creatinine hauv 12 lub hlis dhau los (micromole /L).

• Qhia cov tsos mob rau qhov xav tias AKI: Lub cev qhuav dej (zaum / ntuav / nce nqhis dej / txo qis), cov tsos mob tso zis (oliguria / polyuria / dysuria / haematuria / incontinence / urolith dhau), o (anasarca / ntsej muag & caj dab / sab caj npab / qis dua libs/lwm), hypotension (MAP<65/shock and use of vasopressors/hemhemorrhage), pregnancy and delivery-related symptoms (PV bleeding/ coma/seizures/other), Fever, Traumatic injury (site), allergic reaction (specify), poisoning (specify).

• AKI KDIGO cov txheej txheem raws li kev kuaj mob: nce hauv cov ntshav creatinine los ntawm 0.3 mg/dL lossis ntau dua hauv 48 h LOS YOG, nce hauv cov ntshav creatinine mus txog 1.5 npaug hauv qab lossis ntau dua hauv 7 hnub dhau los LOSSIS, zis tso zis tsawg dua tshaj 0.5 ml/kg/h rau 6 h.

2.3.2. Aetiology

• Tej yam uas ua rau muaj kev loj hlob ntawm AKI: lub cev qhuav dej ( raws plab / ntuav / polyuria / txo kom tsawg), daim siab (hepatorenal syndrome / cirrhosis / mob siab tsis ua hauj lwm), mob plawv (mob myocardial infarct / VHD / plawv tsis ua hauj lwm / pulmonary embolism / kab mob endocarditis / cardiorenal syndrome), hypotension thiab poob siab (cardiogenic shock / hemorrhage / sepsis / tshuaj induced / anaphylaxis / postpartum / hypotension ntawm qhov tsis paub meej), mob raum kab mob (mob glomerular nephritis / interstitial nephritis / pyelonephritis / rhabdomyolysis / intravascular hemolysis), obstructive (sone / qog / prostate mob), kab mob (leptospirosis / dengue / TB, lwm yam kab mob / lwm yam kab mob), muaj feem xyuam rau cev xeeb tub (mis nchuav nrog septic shock / pu erperal sepsis), kab mob (ntau myeloma / SLE / DIC / pre -eclampsia/PPH/hyperemesis gravidarum), nephrotoxic agents (ACEI/ARB, NSAIDS, aminoglycosides/chemotherapy/contrast), lom (yog/no).

• Cov ntshav tsis nyob rau hnub AKI tau lees paub: Urea (umol/L), creatinine (umol/L), thiab cov zis tso zis hauv 24 teev dhau los (MLS).

• Paub qhov chaw kis kab mob (yog/tsis), thiab yog hais tias yog qhia qhov chaw kis kab mob.

• Lwm yam kev ua tsis tiav ntawm lub cev: pulmonary, cardiovascular, hepatic, hematological, neurological, tsis muaj.

2.3.3. Kev tswj hwm

• Kev kho tsis yog mob ntshav qab zib thaum lub sijhawm kuaj AKI: kho kua dej, tshuaj diuretics, vasopressors, tshuaj tua kab mob, tso zis tso zis (percutaneous nephrostomy, cystectomy, urethral catheterization), dej txwv, lwm yam.

• Tus neeg mob tau lim ntshav (yog/tsis).

• Kev taw qhia txog kev pib lim ntshav: kua dej ntau dhau, cov tsos mob uremia, electrolyte lossis acid-based cuam tshuam, intoxication / lom, lwm yam. • Muaj pes tsawg hnub txij li kev kuaj mob AKI mus rau qhov pib hemodialysis (hnub).

• Cov ntshav tsis nyob rau hnub pib hemodialysis: Urea (mmol/L), creatinine (umol/L), tso zis tawm hauv 24 teev dhau los (MLS).

2.3.4. Qhov tshwm sim

• Tus neeg mob raws li txoj cai: ciaj sia / tuag.

• Ua rau tuag taus: raum tsis ua hauj lwm, kis kab mob/sepsis, hlab plawv, poob siab, lub cev qhuav dej, hemorrhage, cev xeeb tub, siab tsis ua hauj lwm, pulmonary mob, neurological, raug mob, lom, kab mob, malignancy, tsis paub

2.4. Cov ntaub ntawv tsom xam

Cov ntaub ntawv tau txheeb xyuas siv Microsoft Excel thiab STATA cov ntaub ntawv software pob. Kev piav qhia thiab cov lus pivot tau ua thawj zaug, ua raws li kev sib piv ntawm binary variables (unpaired t-test tseem ceeb ntawm p < 0.05) thiab qhov tsis kho Kaplan-Meier nkhaus.

3. Cov txiaj ntsig

3.1. Demographics thiab cov yam ntxwv ntawm lub hauv paus

Cov neeg piv txwv (N {{0}}) muaj hnub nyoog li ntawm 18 txog 92 xyoos (txhais tau tias=55.8 xyoo), nrog 66 (57.9%) txiv neej thiab 48 (42.1%) poj niam koom (Table 2). AKI tau txais hauv zej zog tau txheeb xyuas hauv 75% ntawm cov neeg mob (85/114). 80% ntawm cov neeg mob (91/114) tau txais mus rau Department of Internal Medicine, 19% 22/114) mus rau Department of Surgery, thiab 0.9% (1/114) mus rau Department of Obstetrics thiab Gynecology. Thaum nkag mus, 52.6% ntawm cov neeg uas tau nthuav tawm nrog Theem 1 AKI, ua raws li theem 3 AKI (27.2%) thiab theem 2 AKI (20.2%). Cov kev tshawb fawb pawg tau pom los ntawm Cov Kab Mob Tsis Muaj Kab Mob (NCDs), 54 tus neeg mob (47%) nthuav tawm nrog ntshav siab, 49 tus neeg mob (43%) nrog rau mob raum, 47 tus neeg mob (41%) nrog hom 2 mob ntshav qab zib mellitus, 36 tus neeg mob ( 32%) nrog lub plawv tsis ua haujlwm, 1 rooj plaub (1%) nrog mob siab, thiab 49 tus neeg mob (43%) qhia 2 lossis ntau dua ntawm cov kab mob NCD no.

3.2. Qhov xwm txheej

Muaj tag nrho ntawm 114 AKI kev nkag mus rau lub sijhawm 6-lub hlis kawm. Qhov nruab nrab ntawm 19 qhov kev nkag mus rau ib hlis suav rau hauv tsev kho mob qhov xwm txheej ntawm 26.8 rau 1000 kev nkag mus rau 6 lub hlis. Cov pejxeem raws li qhov tshwm sim yog 1880.9 ib lab tus tib neeg hauv ib xyoos. Cov neeg Samoan tam sim no kwv yees li 200, 581 thiab yog li qhov no txhais tau li ntawm 378 AKI ib xyoos.

3.3. Aetiology

Feem ntau ua rau nag lossis daus ntawm AKI yog lub cev qhuav dej (79%) thiab sepsis (64%) (Fig. 2). Cov xwm txheej mob plawv suav nrog 36% ntawm cov neeg mob. Lwm qhov ua rau poob siab (16%), nephrotoxic agents (10%), urinary obstruction (3.6%), mob siab tsis ua hauj lwm (1.8%), thiab cev xeeb tub (0.9%).

3.4. Kev tswj hwm

Cov txheej txheem kev kho mob tseem ceeb yog Intravenous Antibiotics (79%) thiab Intravenous Fluids (63%). Muaj 27 tus neeg mob (24%) uas tau ntsib cov lus qhia rau hemodialysis, thiab 5 tus neeg tau pom zoo los mus txuas ntxiv nrog kev mob hemodialysis siv lub tshuab Fresenius 4008b. Lub sijhawm nruab nrab ntawm AKI kuaj mob mus rau qhov pib ntawm kev lim ntshav yog 2.4 hnub. Cov lus qhia rau hemodialysis yog electrolyte imbalance, acid-base cuam tshuam, thiab / los yog refractory kua overload. Zuag qhia tag nrho, 5 tus neeg mob tau txais qhov nruab nrab ntawm 3.8 zaug ntawm hemodialysis. Ob tus neeg mob tau ntsib kev rov qab los ntawm lub raum ua haujlwm, qhov kev thim rov qab tau tshwm sim hauv qhov nruab nrab ntawm 16 hnub. Ib tus neeg mob tau nce mus rau Kab Mob Ntshav Qab Zib Kawg uas xav tau kev kho hemodialysis mus tas li. Ob tus neeg mob kawg tau tuag thaum tau txais kev kho mob hemodialysis, thiab qhov ua rau tuag yog sepsis.

3.5. Qhov tshwm sim

Thaum lub sijhawm 6-lub hlis kawm, 20.2% (23/114) cov neeg mob tuag thaum nkag. Qhov ua rau tuag taus raws li tau teev tseg hauv daim ntawv pov thawj kev tuag yog Kab Mob Ntshav Qab Zib (35%) thiab Sepsis (35%) (Fig. 3). Lwm qhov ua rau tuag yog kab mob pulmonary (22%), malignancy (4%), thiab cov xwm txheej neurological (4%).

Table 2 Hnub nyoog thiab poj niam txiv neej faib rau cov neeg koom nrog kev kawm.

Fig. 2. Ua rau ua rau AKI

Fig. 3. Ua rau tuag.

Cov neeg mob tau ua raws li 3 lub hlis tom qab tso tawm. Tag nrho ntawm 91 tus neeg mob (79.8%) tau ciaj sia thaum tawm hauv tsev kho mob. AKI tau daws nyob rau hauv 23 qhov teeb meem (25%). AKI tsis tau daws 40 tus neeg mob (40%), ntawm 26 tus neeg paub CKD, thiab 14 yog de-novo mob. Tag nrho ntawm 23 tus neeg mob (25%) tuag hauv peb lub hlis (10 tuag hauv tsev kho mob, 13 tuag hauv tsev). Tag nrho ntawm 5 tus neeg mob (6%) tau ploj mus tom qab.

4. Kev sib tham

Txoj kev tshawb fawb tam sim no tau piav qhia txog qhov kev paub ntawm AKI ntawm cov neeg mob uas tuaj koom lub tsev kho mob hauv tsev kho mob hauv tebchaws Samoa. Nov yog thawj zaug kev tshawb fawb tshawb fawb txog AKI los ntawm lub teb chaws Pacific Island. Ib lub tsev kho mob hauv AKI qhov xwm txheej ntawm 26.8 rau 1000 kev nkag mus rau 6 lub hlis tau suav rau Samoa. Ntawm tag nrho ntawm 114 AKI tsev kho mob, 75% ntawm cov neeg mob tau txais hauv zej zog, thiab ntau dua 40% nthuav tawm nrog NCD co-morbidities. Lub ntsiab precipitating yam rau AKI yog lub cev qhuav dej (79%) thiab sepsis (64%). Tus neeg mob tuag yog 20.2% (n=23), qhov twg 78.3% (n=18) ntawm cov neeg mob tau txais AKI hauv zej zog, thiab 21.7% (n=5) tau nyob hauv tsev kho mob - tau txais AKI. Qhov ua rau tuag taus yog cov kab mob plawv (35%) thiab sepsis (35%). Hauv 3 lub hlis tom qab tso tawm hauv tsev kho mob, 25% ntawm cov neeg mob AKI tau daws tag nrho, 25% ntawm cov neeg mob tau tuag, thiab 18.7% ntawm cov neeg mob AKI tau nce mus rau mob raum.

Nyob rau hauv txoj kev tshawb no, feem ntau ntawm AKI tsev kho mob nthuav qhia yog cov neeg nyob rau hauv 50-69 pawg hnub nyoog uas muaj ntau yam NCD co-morbidities. Qhov kev tshawb pom no ua raws li kev lees paub zoo ntawm NCD kev noj qab haus huv pej xeem teeb meem hauv Pacific Islands, thiab kuj tseem yuav piav qhia tias vim li cas peb cov pej xeem hauv paus tau sib piv rau AKI kev nthuav qhia rau cov teb chaws tau nyiaj tau los ntau dua li cov teb chaws tau nyiaj tsawg-qis nruab nrab (LLMICs) [12 ]. AKI Global Snapshot txoj kev tshawb fawb pom tias AKI hauv LLMICs feem ntau tshwm sim ntawm cov tub ntxhais hluas uas tsis muaj NCD co-morbidities. NCD teebmeem kev noj qab haus huv rau pej xeem tej zaum kuj yog ib feem ntawm qhov tseeb tias AKI tsev kho mob nkag mus rau hauv Samoa (2.7%) zoo ib yam li lub tebchaws tau nyiaj tau los siab Australia (1.6%). Qhov twg Samoan kev paub dhau los yog ib qho ntawm LLMIC qhov chaw yog nyob rau hauv qhov kev faib ua feem ntau ntawm cov zej zog tau txais AKI kev nthuav qhia, qhov kev tshawb pom feem ntau cuam tshuam nrog ntau yam laj thawj rau kev kho mob hauv tsev kho mob qeeb (piv txwv li, thauj / thauj khoom, nyiam cov tshuaj ib txwm muaj).

Hauv peb pawg neeg tshawb fawb, 24% (n=27) ntawm cov neeg mob tau ntsib cov kev qhia rau hemodialysis, thiab ntawm cov no, tsuas yog 18.5% (n=5) tau pib nrog hemodialysis. Muab hais tias peb ntawm cov neeg mob no tuag thaum tab tom kho hemodialysis, tej zaum peb cov pej xeem yuav tsuas xav txog hemodialysis thaum tus neeg mob tseem ceeb heev. Hmoov tsis zoo, txoj hauv kev muaj sia nyob hauv cov xwm txheej zoo li no tsawg. Nws yog nyob sab nraud ntawm txoj kev tshawb no los tshawb txog kev ntseeg kev noj qab haus huv, kev coj cwj pwm, thiab kev coj cwj pwm ntawm cov neeg mob thiab lawv tsev neeg hais txog hemodialysis, thiab qhov no yuav tsum tau txiav txim siab hauv kev tshawb fawb yav tom ntej. Tej zaum nws yuav yog qhov kev tsis txaus siab los mus nrog haemo dialysis nyob rau hauv Samoa yog txuas mus rau kev nkag siab tias nws yog hemodialysis, es tsis yog cov theem siab ntawm cov kab mob uas yuav ua rau tuag taus.

AKI!Tam sim no Initiative yog lub tswv yim thoob ntiaj teb uas tsim kom muaj kev paub ntau dua, kev lees paub, thiab kev tswj hwm ntawm AKI [13]. Kev koom tes nrog kev txhawb nqa kev noj qab haus huv thiab xa cov lus tseem ceeb rau pej xeem kev noj qab haus huv yuav tsum ua kom muaj txiaj ntsig zoo los txo lub nra ntawm AKI hauv Samoa. Ntiaj Teb Lub Raum Hnub (Lub Peb Hlis 10th) yog ib qho kev tshwm sim txhua xyoo uas muaj lub teb chaws platform los qhia txog kab mob raum mob / mob ntev. Cov phiaj xwm no yuav tsum muaj txiaj ntsig zoo rau cov neeg tsim cai tswjfwm kev noj qab haus huv, muab cov pov thawj tias kev nqis peev hauv AKI cov tswv yim tiv thaiv yuav txo cov nyiaj txiag thiab peev txheej ntawm cov kab mob raum mob rau yav tom ntej [14].

Further research to build on the present study is desirable, and opportunities exist under the International Society of Nephrology Dehyduration for Kidney Health Research Initiative. Future studies should be multi-center in design, and should use the international standard reference intervals to define abnormally high creatinine levels (>110 μmol/L for adult males, >90 μmol / L rau cov poj niam laus). Muab hais tias lub cev qhuav dej yog qhov ua rau nag lossis daus hauv peb pawg neeg Samoan, kev sib koom tes ntawm peb pab pawg tshawb fawb thiab cov phiaj xwm ISN no yuav tsum tau txais tos. Cov txiaj ntsig los ntawm Samoa tuaj yeem txhais tau rau lwm lub tebchaws Pacific Island, thiab kev tshawb fawb Pan-Pacific Island yuav raug txiav txim siab.

4.1. Cov kev txwv ntawm kev tshawb fawb tam sim no

The generalizability of the study findings may be compromised by the study design (single-center), cohort sample size, and study duration. The present study focused on the adult population, and we acknowledge that it is important for future studies to investigate kidney disease among children and adolescents. A greater number of cases may have been included in the sample size, however: (1)The serum creatinine criteria (>200 μmol / L) tej zaum yuav tsis suav nrog AKI cov teeb meem ntawm qhov hnyav dua los ntawm kev suav nrog hauv txoj kev tshawb fawb, (2) Kev tsis sib haum xeeb ntawm AKI kev kuaj mob rau hauv tsev kho mob Cov Ntaub Ntawv Xov Xwm Tus Neeg Mob yuav tsis suav nrog cov kev tshawb fawb, thiab (3) creatinine. reagent tau tawm hauv Tshuag rau peb lub lis piam ntawm lub sijhawm kawm, txwv tsis pub txheeb xyuas cov ntaub ntawv. Txoj kev tshawb fawb tam sim no underestimated es tsis overestimated qhov tshwm sim ntawm AKI hauv Samoa.

5. Cov lus xaus

Nov yog thawj zaug kev tshawb fawb tshawb fawb txog AKI hauv Pacific Islands thiab qhia tau hais tias qhov tshwm sim hauv tsev kho mob thiab cov txiaj ntsig tsis zoo ntawm AKI muaj siab hauv Samoa. Txoj kev tshawb no tsim underestimates lub tsev kho mob tseeb thiab lub teb chaws lub nra ntawm AKI. Kev paub ntau dua ntawm qhov tsis pom zoo no tau lees paub ntawm cov pej xeem, tsoomfwv, thiab cov kws tshaj lij kev noj qab haus huv. Tam sim no muaj kev txaus siab thoob ntiaj teb thiab lub zog los daws lub nra hnyav thiab mob raum mob thoob ntiaj teb, thiab Samoa muaj lub sijhawm los coj kev siv zog hauv Pacific Islands.

Provenance and peer review Tsis commissioned, externally peer-reviewed.

Kev pom zoo rau kev ncaj ncees rau txoj kev tshawb fawb tam sim no tau txais los ntawm Fiji National University College Health Research Ethics Committee (CHREC) thiab tsoom fwv ntawm Samoa Ministry of Health - Health Research Committee (MoH-HRC). Gatekeeper kev pom zoo kuj tau txais los ntawm Tus Lwm Thawj Coj Thawj Coj ntawm TTM Tsev Kho Mob.

Thov qhia cov peev txheej nyiaj txiag rau koj qhov kev tshawb fawb Tsis muaj.

Tus sau txoj kev pab Lub luag haujlwm tau ua los ntawm NMC ua ib feem ntawm nws txoj kev kawm Master, thiab MLP thiab FL yog nws tus thawj saib xyuas. Cov npoj yaig AK tau pab nrog kev hloov kho Master's thesis rau hauv hom ntawv tam sim no rau kev tshaj tawm cov ntawv xov xwm.

Thov qhia tej kev tsis sib haum xeeb Tsis muaj kev tsis sib haum xeeb los tshaj tawm.

Cov ntaub ntawv

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