Acute kidney injury (AKI) outcome, a predictor of long-term major adverse cardiovascular events (MACE)

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Background: Chronic kidney disease (CKD) patients who experience superimposed acute kidney injury (AKI) have been shown to be at higher risk of long-term sequelae of AKI when compared to those who do not experience AKI. It remains unclear whether the need for temporary dialysis intervention following superimposed AKI in patients with CKD has any effect on the long-term major adverse cardiovascular events (MACE). This study examines the relationship between temporary dialysis therapy following AKI and long-term major cardiovascular events in patients with background CKD. Methods: The study population consists of adults who developed AKI while on admission at the University of Virginia Medical Center between January 1, 2002 and December 31, 2012, and who had preadmission estimated glomerular filtration rate (eGFR) between 20 and 60 mL/min/1.73 m² and survived beyond 30 days of AKI. Demographic and baseline clinical variables were used to generate propensity score. Survivors who had temporary dialysis were matched to those managed conservatively according to the propensity score in a ratio of 1:3. Results: Overall, 6,634 (n = 381 and 6,253 in the temporary dialysis-requiring AKI and non-dialysis AKI groups respectively) met entry criteria for the full cohort. Of these, 381 (5.7%) received temporary dialysis. There were 3,147 (47.4% of all patients) MACE events during the study period. The crude incidence for MACE after 30 days of AKI was similar in both dialyzed and non-dialyzed patients. After the propensity score matching, the adjusted hazard ratio for MACE in dialyzed versus non dialyzed patients was 1.162 (95% CI 0.978-1.381). Conclusions: Treatment of AKI with temporary dialysis in hospitalized patients with baseline eGFR between 20 and 60 mL/min/1.73 m² was not associated with an increased risk for subsequent admission for MACE. If confirmed by prospective studies, clinicians may not need to worry that the dialysis procedure may contribute to additional risk for long-term MACE in CKD patients with superimposed AKI.

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Dialysis Requirement and Long-Term Major Adverse Cardiovascular Events in Patients with Chronic Kidney Disease and Superimposed Acute Kidney Injury

Omotoso¹,

Turgut²,

Abdel‐Rahman³

et al. 2017

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“…It is well known that dialysis dependence after AKI as well as patients progressing from CKD to ESRD are associated with poor cardiovascular outcomes. In a previous retrospective cohort study, patients with incomplete recovery after AKI, had a higher risk of long-term major adverse cardiovascular events compared to those who recovered [13]. Also, ESRD patients are at an increased risk of coronary events [14].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes and Associated Risk Factors of Post-Hospitalization Dialysis-Dependent Acute Kidney Injury Patients

Rathore

Chopra

Jennie

et al. 2017

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Background/Aims: Acute kidney injury requiring dialysis (AKI-D) is associated with poor outcomes. Centers for Medicare and Medicaid Services have reversed their clarification allowing AKI-D patients to be dialyzed at outpatient dialysis units. Data assessing long-term outcomes of AKI-D patients and their predictors is needed to adopt guidelines to ensure adequate management. We assessed long-term outcomes and associated risk factors of AKI-D patients who survived 90 days post-hemodialysis (HD) initiation. Methods: AKI-D patients surviving hospitalization and dialyzed at a specialized outpatient AKI dialysis unit between April 11, 2012 and December 25, 2013 were prospectively followed. Long-term outcomes of AKI-D patients were obtained by a single provider through a telephone survey, and factors affecting their outcomes were statistically analyzed. Results: Ninety-one out of 108 patients were reached for telephone survey. At baseline (90 days post-HD initiation), 52/91 patients were declared end-stage renal disease (ESRD; group 1) and 39/91 were dialysis-independent (group 2). At the end of an average follow up period of 859.7 days, 32/91 (35.2%) were dialysis-independent (3/52 from group 1 and 29/39 from group 2), with 28/91 dead (25/52 from group 1 and 3/39 from group 2). After adjusting for demographics and comorbidities, baseline renal function, prior AKI, ESRD, and requirement for continuous renal replacement therapy were associated with poor outcomes. Conclusions: Sustaining long-term dialysis independence in AKI-D patients is significant. Baseline renal function, prior AKI, and hemodynamic changes during hospitalization are predictors of long-term outcomes. Meticulous follow up of AKI-D patients in the outpatient dialysis facilities in their first 90 days post-HD initiation is crucial.

“…Our group recently identified increasing age, low baseline estimated glomerular filtration rate (eGFR), African American race, Charlson, comorbidity index score, smoking history, pre-admission history of hypertension, diabetes, CVD, heart failure (HF), peripheral vascular disease, MI and incomplete recovery of renal function as predictors of MACE in AKI [14]. However, little is known about any association between major depression and long-term outcomes of AKI.…”

Section: Introductionmentioning

confidence: 99%

“…Regarding AKI and associated outcomes, a few studies have documented the increased risk of long-term major adverse cardiovascular events (MACE), defined as subsequent admission for acute myocardial infarction (MI), cerebrovascular disease (CVD) or congestive heart failure (CHF) following AKI [12,13,14]. Our group recently identified increasing age, low baseline estimated glomerular filtration rate (eGFR), African American race, Charlson, comorbidity index score, smoking history, pre-admission history of hypertension, diabetes, CVD, heart failure (HF), peripheral vascular disease, MI and incomplete recovery of renal function as predictors of MACE in AKI [14].…”

Section: Introductionmentioning

confidence: 99%

Major Depression and Long-Term Outcomes of Acute Kidney Injury

Balogun

Omotoso²,

Xin³

et al. 2016

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Background: The prevalence of depression and its relationship to poor outcomes in chronic kidney disease are established facts. Such prognostic impact in acute kidney injury (AKI) is not known. This study determines the prognostic implication of a diagnosis of depression on renal recovery and major adverse cardiovascular events (MACE), a new diagnosis of myocardial infarction, cerebrovascular disease (CVD, stroke or transient ischemic attack) or congestive heart failure (CHF) after hospitalization with AKI. Methods: The study population comprises adults admitted to the University of Virginia Medical Center between January 1, 2002 and December 31, 2012 who suffered AKI during admission. Long-term outcomes, MACE and all-cause mortality, were compared between 2 groups; patients with preexisting diagnosis of major depression and those without. Risk adjusted multivariable Cox proportional hazards regression examined the association between major depression and these outcomes. Results: Patients with AKI numbering 11,425 survived beyond 90 days and had data available. Of these patients, 2,519 (22%) were majorly affected by depression; more often, younger patients, females, African Americans, and those with more comorbid conditions, especially CHF, CVD, diabetes, peptic ulcer disease, chronic pulmonary disease and liver disease were found to be affected with depression. Crude hazard ratio for MACE was 1.245, 95% CI 1.150-1.348 and for all-cause mortality 1.186, 95% CI 1.091-1.290; p < 0.001, that is, the cohort with major depression had a long-term risk for MACE and all-cause mortality increased by 24 and 18%, respectively. Conclusion: Patients who develop AKI in hospital and have preexisting major depression are at greater long-term risk of MACE and all-cause mortality.