Chronic kidney disease rather than illness severity predicts medium- to long-term mortality and renal outcome after acute kidney injury

Findlay, Mark; Donaldson, Ken; Robertson, Sue; Almond, Alison; Flynn, Robert; Isles, Chris

doi:10.1093/ndt/gfu185

Cited by 10 publications

(10 citation statements)

References 22 publications

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“…Notably, poor pre-morbid functional status and presence of malignancy were strongly associated with decreased survival at 3 years. Our results corroborate a Scottish study that found underlying CKD among patients commenced RRT to predict long-term mortality rather than severity of acute illness [25]. Finally, our results were robust to excluding patients with pre-existing CKD, those with estimated baseline Cr, and those AKI patients who did not receive RRT.…”

Section: Discussionsupporting

confidence: 88%

Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study

Mildh

Pettilä

Korhonen

et al. 2016

Ann. Intensive Care

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BackgroundThe role of an episode of acute kidney injury (AKI) in long-term mortality among initial survivors of critical illness is controversial. We aimed to determine whether AKI is independently associated with decreased survival at 3 years among 30-day survivors of intensive care.ResultsWe included 2336 30-day survivors of intensive care enrolled in the FINNAKI study conducted in seventeen medical–surgical ICUs in Finland during a 5-month period in 2011–2012. The incidence of AKI, defined by the Kidney Disease: Improving Global Outcomes criteria, was 34.6%, and 192 (8.3%) commenced RRT. The 3-year mortality among AKI patients was 23.5% (95% CI 20.6–26.4%) compared to 18.9% (17.0–20.9%) of patients without AKI, p = 0.01. However, after adjustments using Cox proportional hazards regression, AKI was not associated with decreased 3-year survival (HR 1.05; CI 95% 0.86–1.27), whereas advanced age, poor pre-morbid functional performance, and presence of several comorbidities were. Additionally, we matched AKI patients to non-AKI patients 1:1 according to age, gender, presence of severe sepsis, and a propensity score to develop AKI. In the well-balanced matched cohort, 3-year mortality among AKI patients was 136 of 662 (20.5%; 17.5–23.6%) and among matched non-AKI patients 143 of 662 (21.6%; 18.5–24.7%), p = 0.687. Neither AKI nor RRT was associated with decreased survival at 3 years in the sensitivity analyses that excluded patients (1) with chronic kidney disease, (2) with AKI not commenced renal replacement therapy (RRT), and (3) with estimated pre-admission creatinine, chronic kidney disease, or AKI stage 1.ConclusionAKI was not an independent risk factor for 3-year mortality among 30-day survivors. Increased 3-year mortality among patients with AKI who survive critical illness may not be related to AKI per se, but rather to advanced age and pre-existing comorbidities.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0218-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 88%

Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study

Mildh

Pettilä

Korhonen

et al. 2016

Ann. Intensive Care

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“…Findlayet al further examined the information of patient with renal replacement therapy requiring AKI in Southwest Scotland between 1994 and 2005. The data from this study indicate that the underlying CKD rather than illness severity can predict the medium- to long-term mortality 30 . Macedoet al followed 84 adult survivors of AKI for a median time of 4.1 years and showed that age and serum creatinine levels at hospital discharge were independent factors associated with non-recovery of renal function 31 .…”

Section: The Aki-ckd Connectionmentioning

confidence: 75%

AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms

Wei

Liu

et al. 2017

Kidney International

312

222

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Acute kidney injury (AKI) and chronic kidney disease (CKD) are inter-connected. While AKI-to-CKD transition has been intensively studied, the information of AKI on CKD is very limited. Nonetheless, AKI, when occurring in CKD patients, is known to be more severe and difficult to recover. CKD is associated with significant changes in cell signaling in kidney tissues, including the activation of TGF-β, p53, HIF, and major developmental pathways. At the cellular level, CKD is characterized by mitochondrial dysfunction, oxidative stress, and aberrant autophagy. At the tissue level, CKD is characterized by chronic inflammation and vascular dysfunction. These pathological changes may contribute to the heightened sensitivity of, and non-recovery from, AKI in CKD patients.

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“…Either in terms of disease severity or mortality, we found that CKD unfavorably impacted the COVID-19 infection. Fourth, preexisting CKD is a significant risk factor for worsening of kidney function during a severe infection (71,72). Once complicated by AKI, CKD itself was associated with a higher risk of mortality and less chance of kidney recovery (73).…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Diseases and Acute Kidney Injury in Patients With COVID-19: Evidence From a Meta-Analysis

et al. 2020

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Renal involvement has been implicated in coronavirus disease 2019 (COVID-19), but the related prevalence and prognosis were largely unknown. In this meta-analysis, we searched the literature from PubMed, Embase, through bioRxiv, and medRxiv until April 26, 2020. Studies reporting chronic kidney diseases (CKDs) and/or acute kidney injury (AKI) were included. Demographics, relevant data of disease severity, and patient's prognosis were extracted and aggregated. Twenty-one thousand one hundred sixtyfour patients from 52 peer-reviewed studies were included. Thirty-seven studies (n = 16,922) reported CKD in COVID-19 patients at diagnosis, and the pooled prevalence was 3.52% (95% CI, 1.98-5.48%; I 2 = 93%). Subgroup analysis showed that CKD prevalence was higher in severe cases [odds ratio (OR), 3.42; 95% CI 2.05-5.61; I 2 = 0%] compared to those with non-severe disease and deceased cases (6.46, 3.40-12.29; I 2 = 1%) compared with survivors. Pooled prevalence of CKD was lower in Chinese patients (2.56%; 95% CI, 1.79-3.47%; I 2 = 80%) compared to those outside of China (6.32%; 95% CI, 0.9-16.12%; I 2 = 93%) (p = 0.08). The summary estimates for AKI prevalence was 11.46% (95% CI, 6.93-16.94%). Patients with AKI had a higher prevalence of developing into severe cases (OR, 6.97; 95% CI, 3.53-13.75; I 2 = 0%) and mortality risk (45.79, 36.88-56.85; I 2 = 17%). The prevalence estimates of CKD or AKI were not significantly different from preprint publications (p > 0.05). Our study indicates that renal condition, either in CKD or AKI, is associated with COVID-19 prognosis, and taking care of such patients needs further awareness and investigations.

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Chronic kidney disease rather than illness severity predicts medium- to long-term mortality and renal outcome after acute kidney injury

Abstract: In an unselected series of patients with AKI requiring RRT, underlying CKD rather than illness severity predicted medium- to long-term mortality.

Cited by 10 publications

References 22 publications

Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study

Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study

AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms

Chronic Kidney Diseases and Acute Kidney Injury in Patients With COVID-19: Evidence From a Meta-Analysis

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