AKI May Raise ESRD Risk

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Acute kidney injury (AKI) caused by trauma, illness, or surgery may predispose patients to end-stage renal disease (ESRD), new findings suggest.

These findings indicate that close follow-up is important for these patients,  researchers say. Lifestyle changes and medication can help slow CKD progression and may reduce the incidence of ESRD.

One study focused on elderly patients aged 67 years or older (median 79.2 years). Allan J. Collins, MD, of the U.S. Renal Data System in Minneapolis, led a team that used Medicare claims to identify 233,803 patients hospitalized for any reason in 2000. None had a previous history of kidney injury or ESRD before admission.

The incidence of AKI at baseline was 3.1%. CKD developed in 72.1% of AKI patients within two years, the investigators reported in the Journal of the American Society of Nephrology (2008; published online ahead of print). Additionally, AKI patients were nearly seven times more likely to progress to ESRD than those who had never been injured.

The odds of developing ESRD rose steadily after hospital discharge among patients with a history of AKI but no CKD. It was 0.96% within 30 days, 2.69% within 180 days, 4.08% within 365 days, and 6.96% at the end of two years of follow-up. The likelihood of ESRD for patients without an injury was 0.04%, 0.14%, 0.25%, and 0.49%, respectively.

“Acute kidney injuries have been considered self-limiting, with a good prognosis,” the researchers concluded. “These findings suggest that CKD may be unrecognized or that injury can initiate CKD,” which can progress to ESRD.
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