Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Abstract

Background and objectives AKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.Design, setting, participants, & measurements Patients in the Veterans Affairs (VA) database who had a discharge diagnosis with International Classification of Diseases, Ninth Revision, code of 584.xx (AKI) or 410.xx (MI) and were admitted to a VA facility from October 1999 through December 2005 were selected for analysis. Three groups of patients were created on the basis of the index admission diagnosis and serum creatinine values: AKI, MI, or MI with AKI. Patients with mean baseline estimated GFR,45 ml/min per 1.73 m 2 were excluded. The primary outcomes assessed were mortality, MAKE, and MACE during the study period (maximum of 6 years). The combination of MAKE and MACE-major adverse renocardiovascular events (MARCE)-was also assessed.Results A total of 36,980 patients were available for analysis. Mean age6SD was 66.8611.4 years. The most deaths occurred in the MI+AKI group (57.5%), and the fewest (32.3%) occurred in patients with an uncomplicated MI admission. In both the unadjusted and adjusted time-to-event analyses, patients with AKI and AKI+MI had worse MARCE outcomes than those who had MI alone (adjusted hazard ratios, 1.37 [95% confidence interval, 1.32 to 1.42] and 1.92 [1.86 to 1.99], respectively).Conclusions Veterans who develop AKI in the setting of MI have worse long-term outcomes than those with AKI or MI alone. Veterans with AKI alone have worse outcomes than those diagnosed with an MI in the absence of AKI.

Acute Kidney Injury Predicts Major Adverse Outcomes in Diabetes: Synergic Impact With Low Glomerular Filtration Rate and Albuminuria

“…The risk of subsequent coronary events or stroke was increased in patients with AKI in most studies (8,14,15). A greater risk of hospitalization for heart failure after myocardial infarction or percutaneous coronary revascularization procedure was also noted (7,8).…”

“…More recently, the development of acute kidney injury (AKI) was shown to predict subsequent renal failure and cardiovascular events in selected populations (6)(7)(8).…”

ABT‐719 for the Prevention of Acute Kidney Injury in Patients Undergoing High‐Risk Cardiac Surgery: A Randomized Phase 2b Clinical Trial

“…The AKIN criteria were the most contemporary criteria available at the time of the initial study design; the Kidney Disease: Improving Global Outcomes (KDIGO) criteria (Table 1) were published during the course of protocol development. Major secondary efficacy endpoints included the percentage of patients who developed ≥1 of the following composite endpoints: death, need for any renal replacement therapy (RRT) during the 90‐day postoperative period, or ≥25% reduction in eGFR from baseline to 90 days postsurgery (major adverse kidney events [MAKE])21; percentage of patients who developed AKI as defined by the RIFLE19 or KDIGO22 criteria; maximal changes from baseline in novel AKI biomarkers over a 72‐hour period after clamp release; and length of intensive care unit (ICU) and hospital stays. Per the study protocol, the aforementioned endpoints were only followed out to 90 days postsurgery.…”

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.…”