Incidence and Adverse Outcomes of Acute Kidney Disease: A Systematic Review and Meta-Analysis.

This study sought to summarize these reports and identify study-level characteristics, including the definition of AKD, that may explain the observed heterogeneity.

本研究旨在总结这些报告，并识别可能解释观察到的异质性的研究层面特征，包括AKD的定义。

study_design

Systematic reviewand meta-analysis.

系统评价和荟萃分析。

SETTING & STUDY POPULATIONS: Adults aged≥18 years and not receiving maintenance kidney replacement therapy.

研究设置与研究人群：年龄≥18岁的成年人，且未接受维持性肾脏替代治疗。

selection_criteria_for_studies

Observational studies that assessed the incidenceof AKD and its association with adverse outcomes.

评估急性肾损伤（AKD）发生率及其与不良结果关联的观察性研究。

data_extraction

Two reviewers independently extracted data and assessed study quality.

两位评审员独立提取数据并评估研究质量。

analytical_approach

AKD definitions were classified as (1) Acute Disease Quality Initiative (ADQI) or ADQI-equivalent or (2) KDIGO (Kidney Disease: Improving Global Outcomes) or KDIGO-equivalent.

AKD定义被分类为(1)急性疾病质量倡议(ADQI)或ADQI等效，或(2)肾脏病：改善全球结果(KDIGO)或KDIGO等效。

A random-effects meta-analysiswas used to calculate pooled estimates of incidenceand the relationship between AKD and outcomes (mortality, kidney failure, onset of chronic kidney disease) summarized by ORs and 95% CIs.

使用随机效应的荟萃分析来计算发病率的汇总估计以及AKD与结果（死亡率、肾衰竭、慢性肾病发病）之间的关系，通过比值比(ORs)和95%置信区间(95% CIs)进行总结。

Results

Among 1,883 identified studies, 59, involving nearly 6 million participants, met the inclusion criteria.

在识别的1,883项研究中，有59项研究符合纳入标准，涉及近600万参与者。

Most studies were classified as being of good quality per the Newcastle-Ottawa scale (n=44).

大多数研究根据纽卡斯尔-渥太华量表被分类为质量良好（n=44）。

The pooled incidenceof AKD was higher when defined by ADQI/ADQI-equivalent criteria compared with KDIGO/KDIGO-equivalent criteria (26.6% [95% CI, 20.3-34.9%] vs 11.1% [95% CI, 7.6-16.3%]; P<0.001).

当按照ADQI/ADQI等效标准定义时，急性肾损伤（AKD）的汇总发生率高于按照KDIGO/KDIGO等效标准定义的（26.6% [95% 置信区间, 20.3-34.9%] 对比 11.1% [95% 置信区间, 7.6-16.3%]; P<0.001）。

The pooled OR of all-cause mortality associated with AKD was similar whether defined with KDIGO/KDIGO-equivalent or ADQI/ADQI-equivalent criteria (3.8 [95% CI, 2.2-6.7] vs 3.0 [95% CI, 2.1-4.4]; P=0.5).

无论使用KDIGO/KDIGO等效标准还是ADQI/ADQI等效标准定义，与AKD相关的全因死亡的汇总比值比（OR）相似（3.8 [95% 置信区间, 2.2-6.7] 对比 3.0 [95% 置信区间, 2.1-4.4]; P=0.5）。

After accounting for baseline acute kidney injury status, the incidenceof AKD and its association with all-cause mortality were similar for the 2 definitions.

在考虑基线急性肾损伤状态后，两种定义下急性肾病的发生率及其与全因死亡率的关联相似。

The incidences of AKD were 13.6% and 11.1%, and the ORs for all-cause mortality were not different (4.2 [95% CI, 2.0-8.7] vs 3.8 [95% CI, 2.2-6.7]; P=0.8) using the ADQI/ADQI-equivalent and KDIGO/KDIGO-equivalent definitions, respectively.

急性肾病的发生率分别为13.6%和11.1%，使用ADQI/ADQI等效和KDIGO/KDIGO等效定义时，全因死亡率的比值比没有差异（分别为4.2 [95% 置信区间, 2.0-8.7] 和 3.8 [95% 置信区间, 2.2-6.7]；P=0.8）。

Similar results were observed for the association between AKD and the development of chronic kidney disease, but the association between AKD and kidney failure was stronger in studies that used the KDIGO/KDIGO-equivalent definition.

急性肾损伤与慢性肾病发展的关联结果相似，但在使用KDIGO/KDIGO等效定义的研究中，急性肾损伤与肾衰竭之间的关联更为强烈。

limitations

Heterogeneity persisted across most of the examined subgroups.

在大多数检查过的亚组中，异质性持续存在。

Conclusions

Estimates for AKD incidenceand AKD-associated risk for clinical outcomes vary by the definition used for AKD.

AKD发病率和AKD相关临床结果风险的估计因所使用的AKD定义而异。

These findings inform the assessment of the incidenceand consequences of AKD in research and clinical settings.

这些发现为在研究和临床环境中评估AKD的发病率及其后果提供了信息。

registration

Registered at PROSPERO with identification number CRD42024515828.

已在PROSPERO注册，识别编号为CRD42024515828。

PLAIN-LANGUAGE SUMMARY: In this systematic reviewand meta-analysisof 59 studies involving nearly 6 million participants, we found that acute kidney disease (AKD) is globally prevalent and is associated with higher risks of adverse outcomes, including all-cause mortality, chronic kidney disease, and kidney failure.

简明语言摘要：在这项涉及近600万参与者的59项研究的系统评价和荟萃分析中，我们发现急性肾脏病（AKD）在全球范围内普遍存在，并且与更高的不良结果风险相关，包括全因死亡率、慢性肾脏病和肾衰竭。

Estimates of AKD incidenceand AKD-associated risks of clinical outcomes vary significantly depending on the definition of AKD used.

AKD发生率的估计以及AKD相关临床结果的风险估计因所使用的AKD定义而显著不同。

The selection of the definition for AKD and the presence of baseline acute kidney injury influence the estimate of AKD incidenceand its association with health consequences.

AKD的定义选择以及基线急性肾损伤的存在会影响AKD发生率的估计及其与健康后果的关联。

The findings of this study should guide efforts to refine clinical guidelines and inform public health strategies to address the global burden of AKD more effectively.

本研究的发现应指导努力完善临床指南，并为公共卫生策略提供信息，以更有效地应对全球急性肾损伤（AKD）的负担。