Kidney Int. 2008;74:101-107


CKD increases the risk of hospital-acquired acute renal failure (ARF), a study shows. The greater the degree of underlying renal impairment, the greater the ARF risk.

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Compared with patients who have an estimated glomerular filtration rate (eGFR) of 60 mL/min per 1.73 m2 or higher, those with an eGFR of 45-59 mL/min per 1.73 m2 have a twofold higher risk of hospital-acquired ARF, according to the investigators. Patients with an eGFR of 30-44, 15-29, and less than 15 mL/min per 1.73 m2 have a 6.5, 28.5, and 40 times greater risk, respectively, after adjusting for numerous variables.


The findings are based on a study of hospitalized adult members of Kaiser Permanente Northern California, including 1,746 who experienced dialysis-requiring ARF during hospitalization (mean age 65.4 years) and 600,820 who did not (mean age 57.3 years). All case patients and controls had outpatient serum creatinine measurements before hospitalization.


Chi-yuan Hsu, MD, of the University of California in San Francisco, and colleagues also identified pre-admission baseline diabetes mellitus, diagnosed hypertension, and documented proteinuria as risk factors.


“Better quantification of the impact of baseline kidney function on the risk of ARF should lead to improved risk stratification and clinical decision making regarding whether or not to proceed with interventions that may predispose to ARF or adopt preventive measures to reduce ARF risk,” the authors wrote.