Impact of Recurrent Acute Kidney Injury on Patient Outcomes

Abstract

Background/Aims: Recurrent acute kidney injury (AKI) is common among patients after a first hospitalized AKI. However, little is known about the prognosis of recurrent AKI episodes in chronic kidney disease (CKD) development, cardiovascular events and mortality. Methods: A retrospective study included patients admitted to our Hospital from 2000 to 2010. AKI was defined according to the Acute Dialysis Quality Initiative criteria. In the follow-up period after the first AKI episode, clinical, laboratory data and the number of repeated AKI episodes, etiology and severity were recorded. Results: Among the 359 AKI survivor patients included, 250 new AKI episodes were observed in 122 patients (34%). Variables independently associated to new episodes were: type 2 DM [OR 1.2, 95%CI 1.2-3.8, p=0.001], ischemic heart disease [OR 1.9; 95%CI 1.1-3.6, p=0.012], and SCr at the first AKI event>2,6 mg/dl [OR 1.2; 95%CI 1.03-1.42, p=0.02]. Development of CKD during four years follow-up was more frequent in patients with recurrent AKI, HR [2.2 (95% CI: 1.09-4.3, p=0.003)] and 44% of recurrent AKI patients who developed CKD occurred during the first 6 months after the initial event. Cardiovascular events were more frequent among patients with recurrent AKI patients than in those with one AKI episode (47.2% vs 24%, p=0.001). Mortality at 4 years was higher in the patient subgroup with several episodes of AKI as compared with those with a single episode [HR: 4.5 (95% CI 2.7-7.5) p<0.001]. Conclusion: Episodes of recurrent AKI have a high potential to be associated with relevant complications such as cardiovascular events, mortality and CKD development.

Phenotypes and Baseline Risk Factors of Acute Kidney Injury in Children After Allogeneic Hematopoietic Stem Cell Transplantation

“…We further found that one fifth of the patients developed recurrent AKI and more than one third developed AKD. In the general adult population, recurrent AKIs have been associated with increased risk of cardiovascular events, mortality, and development of CKD in the long term (31). The clinical relevance of AKD is more obscure.…”

Predicting Risk of Recurrent Acute Kidney Injury: A Systematic Review

“…Sample size of studies ranged from 170 to 453,475 (median 2,353; IQR 370.5-15,646.8) patients. Ascertain- ment of AKI and r-AKI was obtained through medical records [15][16], health-care databases [4,5,9,17], regional administration database [6,18], or national data registries [19]. Studies used varying definitions of AKI, based on serum creatinine: RIFLE [6,9,16], KDIGO [5,15], or AKIN criteria [4,[18][19][20].…”

“…Based on the Newcastle-Ottawa scale, 6 of the 10 studies were rated overall good quality (6-8 stars) [4-6, 15, 18-19], 3 studies were deemed fair quality (5-6 stars) [16,17,20], and 1 study was rated poor quality (0-5 stars, with 0 stars in the comparability domain) [9]. Online supplementary Table S2 presents quality assessment domains for each study.…”

“…R-AKI within the same hospital admission was associated with longer inpatient stay and worse short-(28 day) and longer-term survival [5,9,15,19]. R-AKI postdischarge was associated with higher risk of development of CKD, CKD progression, cardiovascular events, and long-term mortality [4,6,17,20].…”

The impact of the NHS electronic-alert system on the recognition and management of acute kidney injury in acute medicine

“…AKI was defined according to the KDIGO definition. 7 As per 2011 Renal Association guidelines, 9 and recent articles, [22][23][24][25] baseline creatinine was defined as the lowest creatinine level recorded within 3 months. If a 3-month creatinine was not available, then AKI was not diagnosed, assuming other criteria were not met.…”