The Clinical Course of Acute Kidney Disease after Cardiac Surgery: A Retrospective Observational Study

Matsuura, Ryo; Iwagami, Masao; Moriya, Hideshige; Ohtake, Takayasu; Hamasaki, Yoshifumi; Nangaku, Masaomi; Doi, Kent; Kobayashi, Shuzo; Noiri, Eisei

doi:10.1038/s41598-020-62981-1

Cited by 38 publications

(61 citation statements)

References 31 publications

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“…16 , 33 Patients with AKI that evolves into acute kidney disease show greater long-term eGFR decreases than patients with AKI who do not develop acute kidney disease. 34 Older age, male sex, Black race, underlying CKD, and AKI severity are known risk factors for AKI progression to acute kidney disease 35 , 36 ; however, the accelerated eGFR decrease following COVID-19–associated AKI persisted after adjusting for these covariates. As in acute tubular necrosis, where patients with acute tubular necrosis due to mixed causes are at higher risk for future CKD than patients with acute tubular necrosis due to a single cause, such as ischemia or nephrotoxins, 37 the multiple concurrent mechanisms of COVID-19–associated AKI may be contributing to the increased eGFR decrease after discharge.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19

et al. 2021

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IMPORTANCE Acute kidney injury (AKI) occurs in up to half of patients hospitalized with coronavirus disease 2019 (COVID-19). The longitudinal effects of COVID-19-associated AKI on kidney function remain unknown. OBJECTIVE To compare the rate of change in estimated glomerular filtration rate (eGFR) after hospital discharge between patients with and without COVID-19 who experienced in-hospital AKI. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at 5 hospitals in Connecticut and Rhode Island from March 10 to August 31, 2020. Patients who were tested for COVID-19 and developed AKI were screened, and those who survived past discharge, did not require dialysis within 3 days of discharge, and had at least 1 outpatient creatinine level measurement following discharge were included. EXPOSURES Diagnosis of COVID-19. MAIN OUTCOMES AND MEASURES Mixed-effects models were used to assess the association between COVID-19-associated AKI and eGFR slope after discharge. The secondary outcome was the time to AKI recovery for the subgroup of patients whose kidney function had not returned to the baseline level by discharge. RESULTS A total of 182 patients with COVID-19-associated AKI and 1430 patients with AKI not associated with COVID-19 were included. The population included 813 women (50.4%); median age was 69.7 years (interquartile range, 58.9-78.9 years). Patients with COVID-19-associated AKI were more likely to be Black (73 [40.1%] vs 225 [15.7%]) or Hispanic (40 [22%] vs 126 [8.8%]) and had fewer comorbidities than those without COVID-19 but similar rates of preexisting chronic kidney disease and hypertension. Patients with COVID-19-associated AKI had a greater decrease in eGFR in the unadjusted model (−11.3; 95% CI,-22.1 to −0.4 mL/min/1.73 m 2 /y; P = .04) and after adjusting for baseline comorbidities (−12.4; 95% CI,-23.7 to −1.2 mL/min/1.73 m 2 /y; P = .03). In the fully adjusted model controlling for comorbidities, peak creatinine level, and in-hospital dialysis requirement, the eGFR slope difference persisted (−14.0; 95% CI,-25.1 to −2.9 mL/min/1.73 m 2 /y; P = .01). In the subgroup of patients who had not achieved AKI recovery by discharge (n = 319), COVID-19-associated AKI was associated with decreased kidney recovery during outpatient follow-up (adjusted hazard ratio, 0.57; 95% CI, 0.35-0.92). CONCLUSIONS AND RELEVANCE In this cohort study of US patients who experienced in-hospital AKI, COVID-19-associated AKI was associated with a greater rate of eGFR decrease after discharge compared with AKI in patients without COVID-19, independent of underlying comorbidities or AKI (continued) Key Points Question What is the association between coronavirus disease 2019 (COVID-19) in patients with acute kidney injury and the longitudinal trajectory of estimated glomerular filtration rate? Findings In this cohort study of 1612 patients with acute kidney injury monitored after their index hospitalization, estimated glomerular filtration rate declined by 11.3 mL/min/ 1.73 m 2 per year faster in patients ...

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Section: Discussionmentioning

confidence: 99%

Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19

et al. 2021

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“…Again, this reflects the real world setting. Fifth, due to low numbers of patients, our renal recovery analysis is hypothesis generating and we were unable to look at incidence of acute kidney disease (AKD), an important interim diagnosis, with increasingly recognised implications for long-term kidney function 45 . However, we note that the specific criteria for AKD have not been agreed 13 .…”

Section: Discussionmentioning

confidence: 99%

Long-term kidney function of patients discharged from hospital after an intensive care admission: observational cohort study

Haines

Powell-Tuck

Leonard

et al. 2021

Sci Rep

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The long-term trajectory of kidney function recovery or decline for survivors of critical illness is incompletely understood. Characterising changes in kidney function after critical illness and associated episodes of acute kidney injury (AKI), could inform strategies to monitor and treat new or progressive chronic kidney disease. We assessed changes in estimated glomerular filtration rate (eGFR) and impact of AKI for 1301 critical care survivors with 5291 eGFR measurements (median 3 [IQR 2, 5] per patient) between hospital discharge (2004–2008) and end of 7 years of follow-up. Linear mixed effects models showed initial decline in eGFR over the first 6 months was greatest in patients without AKI (− 9.5%, 95% CI − 11.5% to − 7.4%) and with mild AKI (− 12.3%, CI − 15.1% to − 9.4%) and least in patients with moderate-severe AKI (− 4.3%, CI − 7.0% to − 1.4%). However, compared to patients without AKI, hospital discharge eGFR was lowest for the moderate-severe AKI group (median 61 [37, 96] vs 101 [78, 120] ml/min/1.73m2) and two thirds (66.5%, CI 59.8–72.6% vs 9.2%, CI 6.8–12.4%) had an eGFR of < 60 ml/min/1.73m2 through to 7 years after discharge. Kidney function trajectory after critical care discharge follows a distinctive pattern of initial drop then sustained decline. Regardless of AKI severity, this evidence suggests follow-up should incorporate monitoring of eGFR in the early months after hospital discharge.

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“…AKI and AKD reflect renal function status in different time periods during the disease process. Although studies have shown that AKD is associated with increased risks of mortality and renal function decline after hospital discharge ( Hsu et al, 2020 ; James et al, 2019 ; Kofman et al, 2019 ; Matsuura et al, 2020 ; Mizuguchi et al, 2018 ), few targeted on patients with AKD after AKI, and the epidemiology of hospitalized patients with AKD after AKI is largely unknown. Whether AKD acts as an important intermediate stage for progression to renal dysfunction, chronic dialysis and mortality after AKI remains to be found.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney disease in hospitalized acute kidney injury patients

Yan

Duan

Liu

et al. 2021

PeerJ

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Background Acute kidney injury (AKI) and chronic kidney disease (CKD) have become worldwide public health problems, but little information is known about the epidemiology of acute kidney disease (AKD)—a state in between AKI and CKD. We aimed to explore the incidence and outcomes of hospitalized patients with AKD after AKI, and investigate the prognostic value of AKD in predicting 30-day and one-year adverse outcomes. Methods A total of 2,556 hospitalized AKI patients were identified from three tertiary hospitals in China in 2015 and followed up for one year.AKD and AKD stage were defined according to the consensus report of the Acute Disease Quality Initiative 16 workgroup. Multivariable regression analyses adjusted for confounding variables were used to examine the association of AKD with adverse outcomes. Results AKD occurred in 45.4% (1161/2556) of all AKI patients, 14.5% (141/971) of AKI stage 1 patients, 44.6% (308/691) of AKI stage 2 patients and 79.6% (712/894) of AKI stage 3 patients. AKD stage 1 conferred a greater risk of Major Adverse Kidney Events within 30 days (MAKE30) (odds ratio [OR], 2.36; 95% confidence interval 95% CI [1.66–3.36]) than AKD stage 0 but the association only maintained in AKI stage 3 when patients were stratified by AKI stage. However, compared with AKD stage 0, AKD stage 2–3 was associated with higher risks of both MAKE30 and one-year chronic dialysis and mortality independent of the effects of AKI stage with OR being 31.35 (95% CI [23.42–41.98]) and 2.68 (95% CI [2.07–3.48]) respectively. The association between AKD stage and adverse outcomes in 30 days and one year was not significantly changed in critically ill and non-critically ill AKI patients. The results indicated that AKD is common among hospitalized AKI patients. AKD stage 2–3 provides additional information in predicting 30-day and one-year adverse outcomes over AKI stage. Enhanced follow-up of renal function of these patients may be warranted.

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The Clinical Course of Acute Kidney Disease after Cardiac Surgery: A Retrospective Observational Study

Cited by 38 publications

References 31 publications

Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19

Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19

Long-term kidney function of patients discharged from hospital after an intensive care admission: observational cohort study

Acute kidney disease in hospitalized acute kidney injury patients

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