BACKGROUND: Studies suggest an association between acute kidney injury (AKI) and long-term risk for chronic kidney disease (CKD), even following apparent renal recovery. Whether the pattern of renal recovery predicts kidney risk following AKI is unknown. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: Patients in the Veterans Health Administration in 2011 hospitalized (> 24 hours) with at least 2 inpatient serum creatinine measurements, baseline estimated glomerular filtration rate > 60 mL/min/1.73 m², and no diagnosis of end-stage renal disease or non-dialysis-dependent CKD: 17,049 (16.3%) with and 87,715 without AKI. PREDICTOR: Pattern of recovery to creatinine level within 0.3 mg/dL of baseline after AKI: within 2 days (fast), in 3 to 10 days (intermediate), and no recovery by 10 days (slow or unknown). OUTCOME: CKD stage 3 or higher, defined as 2 outpatient estimated glomerular filtration rates < 60 mL/min/1.73m² at least 90 days apart or CKD diagnosis, dialysis therapy, or transplantation. MEASUREMENTS: Risk for CKD was modeled using modified Poisson regression and time to death-censored CKD was modeled using Cox proportional hazards regression, both stratified by AKI stage. RESULTS: Most patients' AKI episodes were stage 1 (91%) and 71% recovered within 2 days. At 1 year, 18.2% had developed CKD (AKI, 31.8%; non-AKI, 15.5%; P < 0.001). In stage 1, the adjusted relative risk ratios for CKD stage 3 or higher were 1.43 (95% CI, 1.39-1.48), 2.00 (95% CI, 1.88-2.12), and 2.65 (95% CI, 2.51-2.80) for fast, intermediate, and slow/unknown recovery. A similar pattern was observed in subgroup analyses incorporating albuminuria and sensitivity analysis of death-censored time to CKD. LIMITATIONS: Variable timing of follow-up and mostly male veteran cohort may limit generalizability. CONCLUSIONS: Patients who develop AKI during a hospitalization are at substantial risk for the development of CKD by 1 year following hospitalization and timing of AKI recovery is a strong predictor, even for the mildest forms of AKI.
BACKGROUND: Studies suggest an association between acute kidney injury (AKI) and long-term risk for chronic kidney disease (CKD), even following apparent renal recovery. Whether the pattern of renal recovery predicts kidney risk following AKI is unknown. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: Patients in the Veterans Health Administration in 2011 hospitalized (> 24 hours) with at least 2 inpatient serum creatinine measurements, baseline estimated glomerular filtration rate > 60 mL/min/1.73 m², and no diagnosis of end-stage renal disease or non-dialysis-dependent CKD: 17,049 (16.3%) with and 87,715 without AKI. PREDICTOR: Pattern of recovery to creatinine level within 0.3 mg/dL of baseline after AKI: within 2 days (fast), in 3 to 10 days (intermediate), and no recovery by 10 days (slow or unknown). OUTCOME: CKD stage 3 or higher, defined as 2 outpatient estimated glomerular filtration rates < 60 mL/min/1.73m² at least 90 days apart or CKD diagnosis, dialysis therapy, or transplantation. MEASUREMENTS: Risk for CKD was modeled using modified Poisson regression and time to death-censored CKD was modeled using Cox proportional hazards regression, both stratified by AKI stage. RESULTS: Most patients' AKI episodes were stage 1 (91%) and 71% recovered within 2 days. At 1 year, 18.2% had developed CKD (AKI, 31.8%; non-AKI, 15.5%; P < 0.001). In stage 1, the adjusted relative risk ratios for CKD stage 3 or higher were 1.43 (95% CI, 1.39-1.48), 2.00 (95% CI, 1.88-2.12), and 2.65 (95% CI, 2.51-2.80) for fast, intermediate, and slow/unknown recovery. A similar pattern was observed in subgroup analyses incorporating albuminuria and sensitivity analysis of death-censored time to CKD. LIMITATIONS: Variable timing of follow-up and mostly male veteran cohort may limit generalizability. CONCLUSIONS:Patients who develop AKI during a hospitalization are at substantial risk for the development of CKD by 1 year following hospitalization and timing of AKI recovery is a strong predictor, even for the mildest forms of AKI.
Authors: Edward D Siew; T Alp Ikizler; Michael E Matheny; Yaping Shi; Jonathan S Schildcrout; Ioana Danciu; Jamie P Dwyer; Manakan Srichai; Adriana M Hung; James P Smith; Josh F Peterson Journal: Clin J Am Soc Nephrol Date: 2012-03-15 Impact factor: 8.237
Authors: Cherry Mammen; Abdullah Al Abbas; Peter Skippen; Helen Nadel; Daniel Levine; J P Collet; Douglas G Matsell Journal: Am J Kidney Dis Date: 2011-12-28 Impact factor: 8.860
Authors: Ion D Bucaloiu; H Lester Kirchner; Evan R Norfolk; James E Hartle; Robert M Perkins Journal: Kidney Int Date: 2011-12-07 Impact factor: 10.612
Authors: Jeremie M Lever; Travis D Hull; Ravindra Boddu; Mark E Pepin; Laurence M Black; Oreoluwa O Adedoyin; Zhengqin Yang; Amie M Traylor; Yanlin Jiang; Zhang Li; Jacelyn E Peabody; Hannah E Eckenrode; David K Crossman; Michael R Crowley; Subhashini Bolisetty; Kurt A Zimmerman; Adam R Wende; Michal Mrug; Bradley K Yoder; Anupam Agarwal; James F George Journal: JCI Insight Date: 2019-01-24
Authors: Eric P Cohen; Kim G Hankey; Ann M Farese; George A Parker; Jace W Jones; Maureen A Kane; Alexander Bennett; Thomas J MacVittie Journal: Health Phys Date: 2019-03 Impact factor: 1.316