Acute Kidney Injury Increases Risk of ESRD among Elderly

Abstract

Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged Ն67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for Ն2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% CI 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% CI 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease.

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…As the evidence linking AKI with loss of kidney function [45][46][47][77][78][79][80] , hypertension 81,82 , cardiovascular disease 49,50,83 , and death 46,[83][84][85][86][87] accumulates, determining the optimal care for this growing population is critical. The American Society of Nephrology AKI Advisory Group has highlighted the transition of care as a potential opportunity to reduce the long-term impact of AKI 88 , and hence, AKD.…”

Acute kidney injury in children with sickle cell disease—compounding a chronic problem

“…In addition, several adult studies have demonstrated a dose-response relationship between AKI and CKD, including a higher risk of CKD in those with more severe AKI and also in those with repeated episodes of AKI [35][36][37]. Several pediatric observational studies have also shown a high proportion of CKD in survivors of AKI, ranging from 10 to 69%, but these studies have focused on populations without primary kidney disease [38][39][40][41][42][43][44].…”

Review article: Acute kidney injury in critical illness

“…14 Incomplete or partial recovery of kidney function following AKI is likely to become an increasingly recognized problem, and data suggest these patients also have a lower rate of survival and a higher risk of progression to ESKD. 15,16 An estimated 30% of all critically ill patients have premorbid CKD. 8,17 In patients with a superimposed episode of AKI on CKD, there is a high risk of non-recovery and accelerated progression to ESKD.…”