Achieved blood pressure post-acute kidney injury and risk of adverse outcomes after AKI: A prospective parallel cohort study

Abstract

Background There has recently been considerable interest in better understanding how blood pressure should be managed after an episode of hospitalized AKI, but there are scant data regarding the associations between blood pressure measured after AKI and subsequent adverse outcomes. We hypothesized that among AKI survivors, higher blood pressure measured three months after hospital discharge would be associated with worse outcomes. We also hypothesized these associations between blood pressure and outcomes would be similar among those who survived non-AKI hospitalizations. Methods We quantified how systolic blood pressure (SBP) observed three months after hospital discharge was associated with risks of subsequent hospitalized AKI, loss of kidney function, mortality, and heart failure events among 769 patients in the prospective ASSESS-AKI cohort study who had hospitalized AKI. We repeated this analysis among the 769 matched non-AKI ASSESS-AKI enrollees. We then formally tested for AKI interaction in the full cohort of 1538 patients to determine if these associations differed among those who did and did not experience AKI during the index hospitalization. Results Among 769 patients with AKI, 42 % had subsequent AKI, 13 % had loss of kidney function, 27 % died, and 18 % had heart failure events. SBP 3 months post-hospitalization did not have a stepwise association with the risk of subsequent AKI, loss of kidney function, mortality, or heart failure events. Among the 769 without AKI, there was also no stepwise association with these risks. In formal interaction testing using the full cohort of 1538 patients, hospitalized AKI did not modify the association between post-discharge SBP and subsequent risks of adverse clinical outcomes. Conclusions Contrary to our first hypothesis, we did not observe that higher stepwise blood pressure measured three months after hospital discharge with AKI was associated with worse outcomes. Our data were consistent with our second hypothesis that the association between blood pressure measured three months after hospital discharge and outcomes among AKI survivors is similar to that observed among those who survived non-AKI hospitalizations.

Clinicopathological Characteristics and Prognosis of Lupus Nephritis Patients with Acute Kidney Injury

“…In our study, we found that AKI stage 3, but not stage 1 and 2, is significantly associated with poor long-term renal outcomes and patient survival in LN patients. A recent prospective Chronic Renal Insufficiency Cohort (CRIC) study of 2,177 CKD patients found that AKI patients (495) had lower prehospital eGFR, eGFR slope, and higher proteinuria, and AKI remained an independent predictor of cardiovascular events and death after adjusting for prehospital variables including eGFR, eGFR slope, and proteinuria [21], which was consistent with our results. Muiru AN and colleagues demonstrated that AKI had small association with subsequent CKD progression in a CRIC study of 433 AKI patients (out of 3,150), which may somehow be because 92% of AKI cases were stage 1 or 2 [20].…”

Optimum Care of AKI Survivors Not Requiring Dialysis after Discharge: An AKINow Recovery Workgroup Report

“…The optimal BP target after an episode of AKI is uncertain, but intensive BP control does not seem to worsen rehospitalization or kidney function in the post-AKI population. 53 , 54 Another focus of post-AKI care is the assessment of fluid status and diuretic dosing, which strongly depends on evolving kidney function throughout recovery. 55 Diuretics may be underdosed after AKI due to concern for the small increases in serum creatinine often observed with diuretic exposure.…”