Short- and long-term outcomes after non-severe acute kidney injury

Arias-Cabrales, Carlos; Rodríguez, Eva; Bermejo, Sheila; Sierra, Adriana; Burballa, Carla; Barrios, Clara; Soler, María José; Pascual, Julio

doi:10.1007/s10157-017-1420-y

Cited by 27 publications

(21 citation statements)

References 44 publications

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“…Our study has some limitations, in particular the retrospective nature of the assessment, and the small sample, but our results are in agreement with two previous studies focused in recurrent AKI [10, 26]. …”

Section: Discussionsupporting

confidence: 82%

“…AKI has been considered a self-limiting disease, with good prognosis when recovery is noted during admission [5] However, several studies have suggested that AKI episodes are associated with higher risk of developing chronic kidney disease (CKD), cardiovascular events and overall mortality [6-7], although the mechanisms underlying this association remains poorly understood [8]. Recently, there has been increasing recognition that even patients with AKI with complete recovery, remain at risk for long-term renal complications [9-10]. There are emerging data that the lack of recovery of renal function after AKI is an important contributor to the prevalence and progression of CKD [7, 9].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Recurrent Acute Kidney Injury on Patient Outcomes

Rodríguez

Arias-Cabrales

Bermejo

et al. 2018

Kidney Blood Press Res

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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.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Impact of Recurrent Acute Kidney Injury on Patient Outcomes

Rodríguez

Arias-Cabrales

Bermejo

et al. 2018

Kidney Blood Press Res

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“…For example, markedly differing mortality has been reported when diagnosed in the community (CA‐AKI, 19%‐26%), hospital (HA‐AKI, 30%‐43%) and within the intensive care unit (ICU‐AKI, 22%‐53%) . In surviving patients long‐term consequences are well recognised as survivors are at increased risk of de‐novo/progressive chronic kidney disease (CKD), end‐stage renal disease (ESRD) and early death …”

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confidence: 99%

Epidemiology of emergency department acute kidney injury

et al. 2019

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Aim: The epidemiology of acute kidney injury (AKI) diagnosed in the emergency department (ED) is poorly described. This study describes the incidence, demographics and outcomes of patients diagnosed with AKI in the ED (ED-AKI).Methods: A prospective cohort study was completed in a University Teaching Hospital, (UK) between April and August 2016. In total, 20 421 adult patients attended the ED and had a serum creatinine measurement. The incident ED-AKI patient episodes were compared with a randomly selected cohort of non-AKI ED patients.Results: A total of 572 patients had confirmed eAlert ED-AKI (548 incident cases), incidence 2.8% (of all ED attendances). ED-AKI was associated with a 24.4% in-patient mortality (non-AKI 3.2%, P < .001) of which 22.3% of deaths occurred within 24 hours and 58% within 7 days. Progression of the admission AKI stage to a higher AKI stage was associated with a 38.8% mortality compared with a 21.4% mortality in those who did not progress (P < .001). In multivariate analysis, ED-AKI was an independent risk for mortality (hazard ratio, 6.293; 95% confidence interval, 1.887-20.790, P = .003). For those discharged from hospital, 20.4% of ED-AKI patients re-attend for acute assessment within 30-days post-discharge (non-AKI 7.6%, P < .001). At 90-days post-discharge, 10.0% of ED-AKI patients died (non-AKI 1.4%, P < .001). Twelve months post-discharge 17.8% of ED-AKI patients developed CKD progression or de-novo CKD (non-AKI 6.0%). Conclusion:The ED-AKI is an independent predictor of death. Mortality is predominantly in the early stages of hospital admission, but for those who survive to discharge have significant long-term morbidity and mortality. K E Y W O R D S acute kidney injury, emergency departments, epidemiology Acute kidney injury (AKI) is a common medical emergency, complicating 6% to 18% of all hospital admissions.

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“…An association between AKI and development of CKD has been previously documented in several studies [30,31]. This deleterious evolution could be ascribed to a subclinical damage after different insults, previous studies have also demonstrated that even after fully recovered AKI episodes, some patients develop CKD [32,33]. Some authors described that the intratubular assembly of MAC is one of the principal mediators of chronic tubulointerstitial damage in proteinuric renal disease [34,35].…”

Section: Discussionmentioning

confidence: 98%

Membrane Attack Complex and Factor H in Humans with Acute Kidney Injury

Rodríguez

Gimeno

Arias-Cabrales

et al. 2018

Kidney Blood Press Res

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Background and Aims: Complement system seems to play an important role in the pathogenesis of Acute Kidney Injury (AKI). The aim of this study was to investigate the role of complement system in the pathogenesis of human AKI. For this purpose, we studied Membrane Attack Complex (MAC) and factor H in plasma and kidney tissue in AKI. Methods: Plasmatic concentrations of MAC and Factor H were studied in patients with hospital-acquired AKI and their respective controls. MAC and Factor H expression and localization within the kidney were studied by immunohistochemistry in kidney tissue samples from autopsies. Demographical, past medical, and laboratory data in patients on admission and 3 years after discharge were recorded. Results: Plasmatic MAC concentrations were significantly higher in AKI-patients (5848±3604 vs 3703±1483 mAU/mL, p< 0.01), mainly in the severe cases, as measured by the need of renal replacement therapy, non-recovery of renal function, RIFLE classification and CKD development. MAC deposition was observed in tubular epithelial cell basal membranes, showing a larger number of tubules with MAC deposition, larger perimeter of affected tubules and greater intensity of MAC immunostaining in AKI patients. Factor H concentrations were higher in AKI patients (0.86±0.05 vs 0.60±0.04 mg/mL, p=0.007), showing a strong positive association with plasmatic MAC (r=0.7, p< 0.01)). Factor H immunostaining showed a tubular cytoplasmic pattern, with significant variations in the staining intensity, associated with the severity of histologic damage. Conclusion: Our data confirm that complement system is involved in human AKI, through the lytic action of MAC in tubular epithelial cells. These results suggest that complement system activation in AKI could be related with CKD development.

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Short- and long-term outcomes after non-severe acute kidney injury

Abstract: Even after fully recovered non-severe AKI episodes, some patients develop CKD and those have an increase in the incidence of cardiovascular events and long-term mortality.

Cited by 27 publications

References 44 publications

Impact of Recurrent Acute Kidney Injury on Patient Outcomes

Impact of Recurrent Acute Kidney Injury on Patient Outcomes

Epidemiology of emergency department acute kidney injury

Membrane Attack Complex and Factor H in Humans with Acute Kidney Injury

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