BACKGROUND The long-term predictive ability of acute kidney injury (AKI) classification based on "Kidney Disease: Improving Global Outcomes"(KDIGO) AKI diagnosis criteria has not been clinically validated in diffuse proliferative lupus nephritis (DPLN) patients with AKI. Our objective was to assess the long-term predictive value of KDIGO AKI classification in DPLN patients with AKI. METHODS Retrospective cohort study was conducted by reviewing medical records of biopsy-proven DPLN patients with AKI from the First Affiliated Hospital of Wenzhou Medical University between Jan 1, 2000 and Dec 31, 2014. Multivariate Cox regression and survival analysis were performed. RESULTS One hundred sixty-seven DPLN patients were enrolled,82(49%) patients were normal renal function (No AKI), 40(24%) patients entered AKI-1 stage (AKI-1), 26(16%) patients entered AKI-2 stage (AKI-2) and 19(16%) patients entered AKI-3 stage (AKI-3). The mean follow-up of all patients was 5.1 ± 3.8 years. The patient survival without ESRD of all patients was 86% at 5 years and 79% at 10 years. The patient survival rate without ESRD at 10 yr was 94.5% for No AKI patients, 81.8% for AKI-1 patients, 44.9% for AKI-2 patients and 14.6% for AKI-3 patients. The area under the ROC curve for KDIGO AKI classification to predict the primary end point was 0.83 (95% CI: 0.73-0.93) (P < 0.001). In Cox regression analysis, AKI stage was independently associated with primary endpoint, with an adjusted hazard ratio (HR) of 3.8(95% CI 2.1-6.7, P < 0.001). CONCLUSION Severity of AKI based on KDIGO AKI category was associated with progression to ESRD in DPLN patients. Analytical data also confirmed the good discriminative power of the KDIGO AKI classification system for predicting long-term prognosis of DPLN patients with AKI.

中文翻译：

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急性肾损伤分类对弥漫性增生性狼疮肾炎伴急性肾损伤的长期预测价值。

背景技术基于“肾脏疾病：改善整体结果”（KDIGO）AKI诊断标准的急性肾损伤（AKI）分类的长期预测能力尚未在弥漫性增生性狼疮性肾炎（DPLN）的AKI患者中得到临床验证。我们的目标是评估KDIGO AKI分类对DPLN AKI患者的长期预测价值。方法采用回顾性队列研究方法，回顾性分析2000年1月1日至2014年12月31日温州医科大学附属第一医院经活检证实的DPLN AKI患者的病历。进行多因素Cox回归和生存分析。结果共纳入167例DPLN患者，其中肾功能正常（无AKI）的患者82例（49％），进入AKI-1阶段（AKI-1）的患者40例（24％），26（16％）位患者进入AKI-2期（AKI-2），19（16％）位患者进入AKI-3期（AKI-3）。所有患者的平均随访时间为5.1±3.8年。所有患者在不使用ESRD的情况下在5年时的生存率为86％，在10年时为79％。No AKI患者在10年时无ESRD的患者存活率为94.5％，AKI-1患者为81.8％，AKI-2患者为44.9％，AKI-3患者为14.6％。KDIGO AKI分类的ROC曲线下预测主要终点的面积为0.83（95％CI：0.73-0.93）（P <0.001）。在Cox回归分析中，AKI阶段与主要终点独立相关，调整后的危险比（HR）为3.8（95％CI 2.1-6.7，P <0.001）。结论基于KDIGO AKI类别的AKI严重程度与DPLN患者的ESRD进展有关。