Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury

Bucaloiu, Ion D.; Kirchner, H. Lester; Norfolk, Evan; Hartle, James E.; Perkins, Robert M.

doi:10.1038/ki.2011.405

Cited by 475 publications

(372 citation statements)

References 33 publications

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“…Less data exists on patients who seem to recover baseline renal function after AKI. Our analysis suggests that many of these patients may have unrecognized CKD, findings that are supported by studies showing increased rates of later CKD after apparent recovery from AKI in adults (28,29) and children (30).…”

Section: Relation To Previous Studiessupporting

confidence: 62%

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

Prowle

Kolic²,

Purdell-Lewis³

et al. 2014

Clinical Journal of the American Society of Nephrology

137

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Background and objectives AKI is a risk factor for development or worsening of CKD. However, diagnosis of renal dysfunction by serum creatinine could be confounded by loss of muscle mass and creatinine generation after critical illness.Design, setting, participants, & measurements A retrospective, single center analysis of serum in patients surviving to hospital discharge with an intensive care unit admission of 5 or more days between 2009 and 2011 was performed.Results In total, 700 cases were identified, with a 66% incidence of AKI. In 241 patients without AKI, creatinine was significantly lower (P,0.001) at hospital discharge than admission (median, 0.61 versus 0.88 mg/dl; median decrease, 33%). In 160 patients with known baseline, discharge creatinine was significantly lower than baseline in all patients except those patients with severe AKI (Kidney Disease Improving Global Outcomes category 3), who had no significant difference. In a multivariable regression model, median duration of hospitalization was associated with a predicted 30% decrease (95% confidence interval, 8% to 45%) in creatinine from baseline in the absence of AKI; after allowing for this effect, AKI was associated with a 29% (95% confidence interval, 10% to 51%) increase in predicted hospital discharge creatinine. Using a similar model to exclude the confounding effect of prolonged major illness on creatinine, 148 of 700 patients (95% confidence interval, 143 to 161) would have eGFR,60 ml/min per 1.73 m 2 at hospital discharge compared with only 63 of 700 patients using eGFR based on unadjusted hospital creatinine (a 135% increase in potential CKD diagnoses; P,0.001).Conclusion Critical illness is associated with significant falls in serum creatinine that persist to hospital discharge, potentially causing inaccurate assessment of renal function at discharge, particularly in survivors of AKI. Prospective measurements of GFR and creatinine generation are required to confirm the significance of these findings.

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Section: Relation To Previous Studiessupporting

confidence: 62%

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

Prowle

Kolic²,

Purdell-Lewis³

et al. 2014

Clinical Journal of the American Society of Nephrology

137

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“…This approach has limitations, however, and loss of muscle mass, changes in volume of distribution, changes in renal reserve, and hyperfiltration can confound the assessment of functional recovery [54][55][56][57][58][59][60] . The limitations of using serum creatinine to assess recovery are supported by observational data indicating that AKI is associated with an increased risk of CKD, even when accompanied by an apparent complete return of serum creatinine to baseline levels 61,62 .…”

Section: Consensus Statement 2hmentioning

confidence: 99%

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

et al. 2017

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“…Hospital LOS was significantly higher in patients with AKI (3 days [IQR, 2-5] versus 10 days [IQR, [6][7][8][9][10][11][12][13][14][15][16]] versus 3 days [IQR, 2-5]; P,0.001), and increased with increasing severity of AKI (n=25,859 patients). In multivariable quantile regression analysis, AKI was associated with a 2.8-day higher LOS and a $7082 increase in costs (P,0.001).…”

Section: Los and Costmentioning

confidence: 99%

“…AKI is strongly associated with increased resource utilization (1-3), higher short-and long-term mortality (1,(4)(5)(6)(7)(8)(9), and a higher risk for the development of CKD (10)(11)(12)(13). Since 2004, at least four proposals have been put forth to define and stage AKI.…”

Section: Introductionmentioning

confidence: 99%

Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals

Zeng

McMahon

Brunelli³

et al. 2014

Clinical Journal of the American Society of Nephrology

367

258

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SummaryBackground and objectives At least four definitions of AKI have recently been proposed. This study sought to characterize the epidemiology of AKI according to the most recent consensus definition proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group, and to compare it with three other definitions.Design, setting, participants, & measurements This was a retrospective cohort study of 31,970 hospitalizations at an academic medical center in 2010. AKI was defined and staged according to KDIGO criteria, the Acute Dialysis Quality Initiative's RIFLE criteria, the Acute Kidney Injury Network (AKIN) criteria, and a definition based on a model of creatinine kinetics (CK). Outcomes of interest were incidence, in-hospital mortality, length of stay, costs, readmission rates, and posthospitalization disposition.Results AKI incidence was highest according to the KDIGO definition (18.3%) followed by the AKIN (16.6%), RIFLE (16.1%), and CK (7.0%) definitions. AKI incidence appeared markedly higher in those with low baseline serum creatinine according to the KDIGO, AKIN, and RIFLE definitions, in which AKI may be defined by a 50% increase over baseline. AKI according to all definitions was associated with a significantly higher risk of death and higher resource utilization. The adjusted odds ratios for in-hospital mortality in those with AKI were highest with the CK definition (5.2; 95% confidence interval [95% CI], 4.1 to 6.6), followed by the RIFLE (2.9; 95% CI, 2.2 to 3.6), KDIGO (2.8; 95% CI, 2.2 to 3.6), and AKIN (2.6; 95% CI, 2.0 to 3.3) definitions. Concordance in diagnosis and staging was high among the KDIGO, AKIN, and RIFLE definitions. ConclusionsThe incidence of AKI in hospitalized individuals varies depending on the definition used. AKI according to all definitions is associated with higher in-hospital mortality and resource utilization. AKI may be inappropriately diagnosed in those with low baseline serum creatinine using definitions that incorporate percentage increases over baseline.

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Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury

Cited by 475 publications

References 33 publications

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

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

Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals

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