Long-Term Risk of Coronary Events after AKI

Abstract

The incidence rate of AKI in hospitalized patients is increasing. However, relatively little attention has been paid to the association of AKI with long-term risk of adverse coronary events. Our study investigated hospitalized patients who recovered from de novo dialysis-requiring AKI between 1999 and 2008 using patient data collected from inpatient claims from Taiwan National Health Insurance. We used Cox regression with time-varying covariates to adjust for subsequent CKD and ESRD after discharge. Results were further validated by analysis of a prospectively constructed database. Among 17,106 acute dialysis patients who were discharged, 4869 patients recovered from dialysis-requiring AKI (AKI recovery group) and were matched with 4869 patients without AKI (non-AKI group). The incidence rates of coronary events were 19.8 and 10.3 per 1000 person-years in the AKI recovery and non-AKI groups, respectively. AKI recovery associated with higher risk of coronary events (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.36 to 2.04) and all-cause mortality (HR, 1.67; 95% CI, 1.57 to 1.79) independent of the effects of subsequent progression to CKD and ESRD. The risk levels of de novo coronary events after hospital discharge were similar in patients with diabetes alone and patients with AKI alone (P=0.23). Our results reveal that AKI with recovery associated with higher long-term risks of coronary events and death in this cohort, suggesting that AKI may identify patients with high risk of future coronary events. Enhanced postdischarge follow-up of renal function of patients who have recovered from temporary dialysis may be warranted. The incidence rate of AKI in hospitalized patients is increasing 1 and the number of deaths associated with dialysis-requiring AKI has more than doubled. 2 In hospitalized patients, AKI results in increased in-hospital and posthospitalization resource use. 3 Currently, the incidence rate of dialysis-requiring AKI is higher than the rate of ESRD, and its annual growth rate is as high as 10% in the United States. 4 Along with the advances in critical care medicine and dialysis technologies, the probability of being discharged alive after temporary AKI has been rising among hospitalized patients. 5 It has been noticed

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

“…These patients may nonetheless be vulnerable to further kidney damage and other adverse events. As has been shown previously, patients who have suffered an AKI event and 'recover' still carry a long-term increased risk of major adverse cardiac and kidney events 49,76 . Patients with AKD stage 0A might still require follow-up and could likely benefit from avoiding unnecessary nephrotoxic drugs.…”

“…Acute kidney disease AKI is a risk factor for the future loss of kidney function, cardiovascular disease, and death 11,[45][46][47][48][49][50] . Defining optimal follow-up care for this high-risk population is therefore essential, especially during the transition of care beyond the acute care setting when recovery from AKI and its underlying precipitants might be ongoing.…”

“…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.…”

Cardiovascular-Specific Mortality and Kidney Disease in Patients Undergoing Vascular Surgery

“…[36][37][38][39][40] Patients with AKI have an increased risk for coronary angiography, coronary artery bypass grafting surgery, myocardial infarction, congestive heart failure, and stroke regardless of any progression to CKD. [41][42][43] Major open vascular surgery, with the risk for intraoperative hypotension and the frequent need to cross-clamp the aorta, has long had an association with renal failure. 44 Modern vascular surgery relies heavily on preoperative and, especially with endovascular procedures, intraoperative contrast enhanced imaging and thus carries an increased risk for contrastinduced AKI.…”

“…[36][37][38][39][40] Patients with AKI have an increased risk for coronary angiography, coronary artery bypass grafting surgery, myocardial infarction, congestive heart failure, and stroke regardless of any progression to CKD. [41][42][43] Huber et al …”