What is the real impact of acute kidney injury?

Bedford, Michael; Stevens, Paul E.; Wheeler, Toby; Farmer, Chris

doi:10.1186/1471-2369-15-95

Cited by 83 publications

(65 citation statements)

References 27 publications

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“…This has stark clinical and financial implications, especially if it is confirmed that the prevalence and incidence of CA‐AKI truly exceeds HA‐AKI. The economic burden of HA‐AKI has been well described . Using the current evidence, it will be important to estimate the economic burden imposed by CA‐AKI and allocate resources accordingly.…”

Section: Epidemiologymentioning

confidence: 99%

Community‐acquired acute kidney injury: A challenge and opportunity for primary care in kidney health

et al. 2016

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ABSTRACT:Community-acquired acute kidney injury (CA-AKI) has been found to be a common event in the population. Current incidence estimates are not available, but evaluations of severe elevations in serum creatinine indicate that incidence can be as high as 989 cases per million population in those older than 80 years. Data on risk factors are limited, but older age and higher comorbid illness burden, especially diabetes and cardiovascular disease, seem to be more common in patients who suffer CA-AKI. In addition to being more common than hospital-acquired AKI, the long-term sequelae of CA-AKI seem to be just as severe, including renal disease progression and mortality. Efforts to better understand the aetiology of CA-AKI and how ultimately to prevent the development of this condition will need to be taken. In the meantime, a concerted effort by general internists and nephrologists will be needed to prevent CA-AKI in the highest risk patients and thus limit the poor outcomes associated with this entity.

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Section: Epidemiologymentioning

confidence: 99%

Community‐acquired acute kidney injury: A challenge and opportunity for primary care in kidney health

et al. 2016

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“…Acute kidney injury (AKI) occurs in 1 in 7 hospital admissions 1 . Even those with small increases in creatinine levels have 4-fold greater hospital mortality than those with no creatinine level increase 2 .…”

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confidence: 99%

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Sawhney

Marks

Fluck

et al. 2017

American Journal of Kidney Diseases

195

189

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BackgroundThe long-term prognosis after acute kidney injury (AKI) is variable. It is unclear how the prognosis of AKI and its relationship to prognostic factors (baseline kidney function, AKI severity, prior AKI episodes, and recovery of kidney function) change as follow-up progresses.Study DesignObservational cohort study.Setting & ParticipantsThe Grampian Laboratory Outcomes Morbidity and Mortality Study II (GLOMMS-II) is a large regional population cohort with complete serial biochemistry and outcome data capture through data linkage. From GLOMMS-II, we followed up 17,630 patients hospitalized in 2003 through to 2013.PredictorsAKI identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine criteria, characterized by baseline kidney function (estimated glomerular filtration rate [eGFR] ≥ 60, 45-59, 30-44, and <30 mL/min/1.73 m2), AKI severity (KDIGO stage), 90-day recovery of kidney function, and prior AKI episodes.OutcomesIntermediate- (30-364 days) and long-term (1-10 years) mortality and long-term renal replacement therapy.MeasurementsPoisson regression in time discrete intervals. Multivariable Cox regression for those at risk in the intermediate and long term, adjusted for age, sex, baseline comorbid conditions, and acute admission circumstances.ResultsOf 17,630 patients followed up for a median of 9.0 years, 9,251 died. Estimated incidences of hospital AKI were 8.4% and 17.6% for baseline eGFRs ≥ 60 and <60 mL/min/1.73 m2, respectively. Intermediate-term (30-364 days) adjusted mortality HRs for AKI versus no AKI were 2.48 (95% CI, 2.15-2.88), 2.50 (95% CI, 2.04-3.06), 1.90 (95% CI, 1.51-2.39), and 1.63 (95% CI, 1.20-2.22) for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m2, respectively. Among 1-year survivors, long-term HRs were attenuated: 1.44 (95% CI, 1.31-1.58), 1.25 (95% CI, 1.09-1.43), 1.21 (95% CI, 1.03-1.42), and 1.08 (95% CI, 0.85-1.36), respectively. The excess long-term hazards in AKI were lower for lower baseline eGFRs (P for interaction = 0.01).LimitationsNonprotocolized observational data. No adjustment for albuminuria.ConclusionsThe prognostic importance of a discrete AKI episode lessens over time. Baseline kidney function is of greater long-term importance.

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“…Some of these risk factors are common between CKD and AKI, and they included metabolic syndrome, obesity, proteinuria, HTN, and vascular abnormalities. These comorbidities can also play a role in the development of CKD following AKI [21,41] . On the other hand, there is an established association between OSA and the above-named chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study

Dou

Lan

Reynolds

et al. 2016

Nephron

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Background/Aims: Obstructive sleep apnea (OSA) is a known risk factor for chronic kidney disease (CKD); however, its association with acute kidney injury (AKI) is not well documented. We aimed to study whether OSA is associated with the risk of AKI in the intensive care unit (ICU) setting. Methods: All consecutive adult Olmsted County, MN residents who were admitted in Mayo Clinic ICUs from January 1, 2010 to December 31, 2010 were screened. Chronic and acute risk factors were collected within the first 48 h of ICU admission. Logistic regression and propensity score matching were used to examine crude and adjusted associations of OSA with AKI. Results: Among 1,259 enrolled ICU patients, 183 patients had a diagnosis of OSA prior to the index ICU admission. Compared with non-OSA patients, the incidence of AKI in OSA patients was more frequent (41 vs. 57%, p < 0.001). In univariate analysis, it was found that CKD, age, gender, Caucasian race, congestive heart failure, cerebrovascular disease, diabetes mellitus, body mass index, and OSA were associated with AKI. In the multivariate model, following adjustment for age, gender, race, and chronic and acute risk factors, OSA was found to have an independent association with AKI (OR 1.53; 95% CI 1.04-2.24; p = 0.031). Among 176 propensity score matched pairs, there was a significant difference in the incidence of AKI between the OSA and non-OSA groups (OR 1.54; 95% CI 1.01-2.35; p = 0.04). Conclusions: The history of OSA diagnosed by polysomnography is associated with higher risk of AKI in critically ill patients.

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What is the real impact of acute kidney injury?

Cited by 83 publications

References 27 publications

Community‐acquired acute kidney injury: A challenge and opportunity for primary care in kidney health

Community‐acquired acute kidney injury: A challenge and opportunity for primary care in kidney health

Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study

Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study

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