Hospitalized patients with acute kidney injury (AKI) have a higher risk for cardiovascular events, especially heart failure, in the year after discharge than those without AKI, according to new study findings published in the Clinical Journal of the American Society of Nephrology.
Of 146,931 patients admitted to 21 hospitals within Kaiser Permanente Northern California (KPNC) health system from 2006 to 2013, 31,245 experienced AKI, based on Kidney Disease: Improving Global Outcomes diagnostic criteria. AKI was independently associated with an 18% higher risk of hospitalization for heart failure and atherosclerotic events in the 365 days after discharge, Alan S. Go, MD, and colleagues from Kaiser Permanente reported. The investigators accounted for a wide range of confounders—including demographics, comorbidities, preadmission estimated glomerular filtration rate and proteinuria, heart failure, and sepsis-complicating hospitalization, intensive care unit admission, hospital length of stay, and predicted in-hospital mortality.
After further analyses, AKI was associated with a significant 44% increased risk for heart failure, but not other atherosclerotic events.
“The reasons for why AKI was more strongly associated with subsequent heart failure than atherosclerotic events are not clear, but if the association is proven to be causal, it may be related to differential effects of aberrations in inflammatory, endothelial dysfunction, and other pathways associated with AKI or possible differences in therapy (e.g., use or dosage of renin-angiotensin system inhibitors or diuretics) after an AKI episode,” Dr Go and the team wrote.
In an accompanying editorial, Steven G. Coca, DO, MS, of the Icahn School of Medicine at Mount Sinai in New York, commented that the study by Dr Go’s team “was a strong and meticulous analysis that leveraged the KPNC population.”
“The amount and degree of adjustment for potential confounders was probably the most robust of any large retrospective study of AKI that has been published, and the authors should be commended for this level of rigor,” Dr Coca observed.
Go AS, Hsu CY, Yang J, et al. Acute kidney injury and risk of heart failure and atherosclerotic events. Clin J Am Soc Nephrol. CJN.12591117 [Published online May 17, 2018]
Coca SG. Ptolemy and copernicus revisited: The complex interplay between the kidneys and heart failure. Clin J Am Soc Nephrol. [Published online May 17, 2018]
Acute kidney injury during hospitalization linked with higher risk of heart filure after discharge. American Society of Nephrology; May 17, 2018. [news release]