The Impact of Acute Kidney Injury on the Long‐term Risk of Stroke

Abstract

BackgroundThe incidence of acute kidney injury (AKI) requiring dialysis in hospitalized patients is increasing; however, information on the long‐term incidence of stroke in patients surviving to discharge after recovering from AKI after dialysis has not been reported.Methods and ResultsPatients that survived after recovery from dialysis‐requiring AKI during index hospitalizations from 1999 to 2008 were identified in nationwide administrative registries. The risk of de novo stroke and death were analyzed with time‐varying Cox proportional hazard models. The results were validated by a critical care database. We enrolled 4315 patients in the AKI‐recovery group (men, 57.7%; mean age, 62.8±16.8 years) and matched 4315 control subjects as the non‐AKI group by propensity scores. After a median follow‐up period of 3.36 years, the incident stroke rate was 15.6 per 1000 person‐years. The AKI‐recovery group had higher risk (hazard ratio: 1.25; P=0.037) and higher severity of stroke events than the non‐AKI group, regardless of progression to subsequent chronic kidney disease. The rate of incident stroke was not statistically different in those with diabetes alone (without AKI) and in those with AKI alone (without diabetes) after hospital discharge (P=0.086). Furthermore, the risk of mortality in the AKI‐recovery group was higher than in the non‐AKI group (hazard ratio: 2.4; P<0.001).ConclusionsThe patients who recovered from AKI had a higher incidence of developing incident stroke and mortality than the patients without AKI, and the impact was similar to diabetes. Our results suggest that a public health initiative is needed to enhance postdischarge follow‐up of renal function and to control the subsequent incidence of stroke among patients who recover from AKI after dialysis.

Promoting Kidney Function Recovery in Patients with AKI Requiring RRT

“…In the second study, 4315 AKI-D survivors who were alive and dialysis free at 30 days were matched with controls. After a mean follow-up of 3 years, patients with AKI-D had a higher risk of stroke (adjusted HR, 1.25) and a higher severity of stroke events (17). Remarkably, AKI-D conferred a future risk of coronary events (12) or stroke (17) that was similar to the risk conferred by diabetes.…”

“…Although alive and dialysis free at 90 days is clearly an important milestone, AKI-D survivors remain at risk for serious complications within the next 1-5 years (6,12,(15)(16)(17)32). The risk of ESRD after AKI-D after early dialysis independence is substantial, ranging from 8% to 21% of survivors (12,39).…”

“…Overall in-hospital mortality of patients with AKI-D is 33% (7) and between 50% and 60% in the intensive care unit (ICU) (8,9). Survivors of AKI-D are at risk for long-term complications, including CKD (10-13), ESRD (2,14), bone fractures (15), upper gastrointestinal bleeding (16), stroke (17), and cardiovascular events, including MI and congestive heart failure (6,12). Because observational studies suggest that adverse outcomes are mitigated when the severity and duration of AKI is reduced (18,19), it is hypothesized that targeted measures to facilitate kidney function recovery might improve both kidney-and nonkidneyrelated outcomes.…”

Leveraging Big Data and Electronic Health Records to Enhance Novel Approaches to Acute Kidney Injury Research and Care

“…In a number of patient populations, AKI has been associated with increased risk for CKD, proteinuria, hypertension, cardiovascular disease, and stroke [47,48,49,50,51]. Despite the ongoing morbidity risk that exists well after the event itself, patients who experience AKI rarely receive the follow-up care they warrant [52].…”

Care of the Acute Kidney Injury Survivor

“…Several studies have highlighted the relationship between AKI and subsequent myocardial infarction [8], stroke [9] and heart failure [10, 11]. Most recently, Chawla et al[6] highlighted that among veterans admitted with a myocardial infarction, super-imposed AKI during the index hospitalization portended a higher risk of major adverse cardiovascular events (defined as the composite of stroke, heart failure or recurrent myocardial infarction) over the ensuing follow-up that extended to 6 years (aHR 1.24, 95% CI 1.18–1.30 as compared to patients with a myocardial infarction uncomplicated by AKI) [6].…”