Timing of Recovery From Moderate to Severe AKI and the Risk for Future Loss of Kidney Function

Siew, Edward D.; Abdel-Kader, Khaled; Perkins, Amy M.; Greevy, Robert A.; Parr, Sharidan K.; Horner, Jeffrey; Vincz, Andrew J.; Denton, Jason; Wilson, Otis; Hung, Adriana M.; Robinson‐Cohen, Cassianne; Matheny, Michael E.

doi:10.1053/j.ajkd.2019.05.031

Cited by 56 publications

(61 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Its role was to review the literature of consensus definitions in other domains 20,21,23,24 and develop a scope-of-work document pertinent to nephrology and kidney failure. Table 1 19,[25][26][27] describes the complete process.…”

Section: Methodsmentioning

confidence: 99%

“…We noted that a doubling of creatinine was a particularly strong predictor of end-stage kidney disease. A 57% eGFR decline over 2 years (i.e., about a doubling of creatinine) is associated with a 32-times increased risk for kidney failure 27 in those with an eGFR <60 ml/min per 1.73 m 2 . This surrogate may be particularly suitable for trials using routine healthcare data for follow-up, in which it is not always possible to collect additional measurements.…”

Section: Sustained Low Gfrmentioning

confidence: 99%

See 1 more Smart Citation

International consensus definitions of clinical trial outcomes for kidney failure: 2020

Levin

Agarwal

Herrington

et al. 2020

Kidney International

View full text Add to dashboard Cite

Kidney failure is an important outcome for patients, clinicians, researchers, healthcare systems, payers, and regulators. However, no harmonized international consensus definitions of kidney failure and key surrogates of progression to kidney failure exist specifically for clinical trials. The International Society of Nephrology convened an international multistakeholder meeting to develop consensus on this topic. A core group, experienced in design, conduct, and outcome adjudication of clinical trials, developed a database of 64 randomized trials and the 163 included definitions relevant to kidney failure. Using an iterative process, a set of proposed consensus definitions were developed and subsequently vetted by the larger multi-stakeholder group of 83 participants representing 18 different countries. The

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Sustained Low Gfrmentioning

confidence: 99%

International consensus definitions of clinical trial outcomes for kidney failure: 2020

Levin

Agarwal

Herrington

et al. 2020

Kidney International

View full text Add to dashboard Cite

show abstract

“…Timing of exercise There are many different recovery trajectories following AKI, with individuals either having early recovery prior to discharge, late recovery or non-recovery [68]. Observational studies [68,69] investigating recovery following AKI indicate that recovery continues post discharge with late recovery still clearly associated with better outcomes than non-recovery. Therefore, an exercise intervention would be most effective in the three months following the AKI insult, since renal recovery appears to continue up until this point [70].…”

Section: Considerations For the Implementation Of Future Clinical Stumentioning

confidence: 99%

Exercise as a therapeutic option for acute kidney injury: mechanisms and considerations for the design of future clinical studies

2020

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a known risk factor for chronic kidney disease (CKD) and end stage kidney disease (ESKD). The progression from AKI to CKD, despite being well recognised, is not completely understood, although sustained inflammation and fibrosis are implicated. A therapeutic intervention targeting the post AKI stage could reduce the progression to CKD, which has high levels of associated morbidity and mortality. Exercise has known anti-inflammatory effects with animal AKI models demonstrating its use as a therapeutic agent in abrogating renal injury. This suggests the use of an exercise rehabilitation programme in AKI patients following discharge could attenuate renal damage and improve long term patient outcomes. In this review article we outline considerations for future clinical studies of exercise in the AKI population.

show abstract

“…The primary outcome was a composite of new-onset CKD (defined by eGFR < 60 mL/min/1.73m 2 at least twice separated by 90 days with no intervening values ≥ 60 mL/min/1.73m 2 ) or a sustained 30% decline in eGFR compared to baseline for more than 90 days with no interim eGFR reflecting a < 20% decline from the baseline. 18 A 30% decline in eGFR was chosen based on data indicating that this is predictive of future end-stage renal disease (ESRD). 19 As a secondary outcome, we defined "rapid eGFR decline" as >3mL/min/1.73m 2 decline per year, which is associated with ESRD and adverse cardiovascular outcomes.…”

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

Clinically significant estimated glomerular filtration rate decline is common in patients receiving immune checkpoint inhibitors: implications for long-term cancer survivors

Chute

Zhao

Strohbehn

et al. 2020

Preprint

View full text Add to dashboard Cite

PurposeImmune checkpoint inhibitors (ICIs) are now indicated in more than one in three cancer patients. Acute kidney injury has emerged as an important complication of ICIs; however, there are no studies characterizing the long-term effects of ICIs on kidney function.MethodsRetrospective cohort study of consecutive adult cancer patients treated with ICIs between 2010–2018 at two major cancer centers. The primary aim was to determine the composite outcome of incident or progressive CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 or a ≥30% decline in eGFR sustained >90 days among patients surviving ≥1 year. The secondary objective was to determine the proportion of patients experiencing rapid eGFR decline defined as >3mL/min/1.73m2 per year decline.ResultsA total of 5004 adult patients with cancer (mean [SD] age, 64 [13] years; 2699 [54%] male; 4529 [91%] White non-Hispanic) were included, and 2563 surviving ≥1 year were analyzed. During a median follow-up of 688 days (interquartile range, 496 to 1031), the overall event rate of the primary composite outcome was 17% and 20% at 3 and 5 years, respectively. Fine-Gray subdistribution multivariable hazard mode demonstrated that age and coronary artery disease were each independently associated with the primary outcome, adjusted HR (95% CI) 1.12 (1.06, 1.19) per 5 years and 1.27 (1.00-1.62), p < 0.001 and p=0.49, respectively.ConclusionNew onset CKD or 30% eGFR decline is common in patients receiving ICIs who survive ≥1 year. As ICIs are increasingly used in earlier stage cancers, the impact of long term kidney function decline among survivors is extremely important. Additional studies are needed to determine the risk factors and potential modifiers for eGFR decline among patients receiving ICIs.

show abstract

Timing of Recovery From Moderate to Severe AKI and the Risk for Future Loss of Kidney Function

Cited by 56 publications

References 38 publications

International consensus definitions of clinical trial outcomes for kidney failure: 2020

International consensus definitions of clinical trial outcomes for kidney failure: 2020

Exercise as a therapeutic option for acute kidney injury: mechanisms and considerations for the design of future clinical studies

Clinically significant estimated glomerular filtration rate decline is common in patients receiving immune checkpoint inhibitors: implications for long-term cancer survivors

Contact Info

Product

Resources

About