Acute Kidney Injury Increases Risks for CKD, ESRD, and Mortality

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In a meta-analysis, the risks for premature death nearly doubled, CKD nearly tripled, and ESRD nearly quintupled after an episode of acute kidney injury.
In a meta-analysis, the risks for premature death nearly doubled, CKD nearly tripled, and ESRD nearly quintupled after an episode of acute kidney injury.

Acute kidney injury (AKI) substantially increases the risks for future kidney damage and death, according to a new study.

Rinaldo Bellomo, MD, of the University of Melbourne, Melbourne, Victoria, Australia, and colleagues conducted a systematic review and meta-analysis of 82 studies that included 2,017,437 patients, of whom 12.7% had AKI. Patients with AKI had higher event rates, per 100 person-years, than those without AKI with respect to chronic kidney disease (CKD, 17.8 vs 7.6), end-stage renal disease (ESRD, 0.5 vs 0.1), and death (13.2 vs 7.3). The presence of AKI, compared with its absence, was associated with a 2.7-, 4.8-, and 1.8-fold increased risk of new or progressive CKD, ESRD, and death, respectively, Dr Bellomo's team reported in Kidney International.

CKD, ESRD, and death risks increased along with AKI severity. In addition, death risk was influenced by baseline kidney function (estimated glomerular filtration rate ranged from 41 to 128 mL/min/1.73 m2), diabetes, coronary heart disease, and clinical setting (i.e., angiography, cardiovascular surgery, hospital, or intensive care unit). Patients undergoing angiography and those with stage 3 AKI had the highest risks.

“This study provides robust estimates of the increased risk of adverse outcomes after AKI,” Dr Bellomo and colleagues stated. “Notably, this risk was demonstrated across all stages of injury and across all clinical settings.”

Research has shown that AKI activates a spectrum of maladaptive cellular repair processes, the investigators noted.

“Communication of future risk to AKI survivors provides the opportunity to engage them in health-seeking behaviors, optimize other CKD risk factors, reconcile medications, and receive education surrounding prevention of further injury,” Dr Bellomo's team wrote.

For older adults with limited life expectancy, they suggested focusing on management of cardiovascular risk factors and prevention of further episodes of AKI and hospital readmission.

AKI was defined according to RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease), AKIN (AKI Network), or KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The median study follow-up was 2.9 years. Included studies were conducted in the United States, Europe, or Asia. None originated from Africa, which is a limitation. The investigators also noted common sources of bias in the studies, including incomplete reporting of outcome data, missing biochemical values, and inadequate adjustment for confounders.

Reference

See EJ, Jayasinghe K, Glassford N, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. DOI:10.1016/j.kint.2018.08.036

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