Whether and when acute kidney injury (AKI) resolves may be key factors in the development of long-term major adverse kidney events (MAKE), according to investigators.

Among 1538 hospitalized participants in the ASSESS-AKI (Assessment, Serial Evaluation, and Subsequent Sequelae) study, 50% had no AKI, 31% had resolving AKI (a decrease in serum creatinine of at least 0.3 mg/dL or 25% from maximum value within 72 hours), and 19% had nonresolving AKI.

Over a median 4.7 years, patients with nonresolving and resolving AKI had significant 2.3- and 1.5-fold higher risks for MAKE, respectively, compared with patients without AKI, Jonathan Himmelfarb, MD, of University of Washington in Seattle, and colleagues reported in JAMA Network Open. The investigators defined MAKE as a composite of chronic kidney disease incidence and progression, initiation of long-term dialysis, or death from any cause during study follow-up. Neither AKI severity defined byKidney Disease Improving Global Outcomes (KDIGO) stage (74% had stage 1 AKI) nor the magnitude of increased serum creatinine fully explained the risks.

“This study suggests that the 72-hour period immediately after AKI distinguishes the risk of clinically important kidney-specific long-term outcomes,” Dr Himmelfarb’s team stated.


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Nonresolving AKI was associated with a significant 1.5-fold higher risk for MAKE than resolving AKI, the investigators also reported. A significantly greater proportion of patients with nonresolving AKI experienced new-onset CKD (39% vs 24%), but the association held even when these patients were excluded.

In an accompanying editorial, Ravindra L. Mehta, MBBS, MD, DM, of the University of California San Diego, commented that the study “highlights the shortfall of current AKI staging criteria used alone in assessing outcomes, as the severity stage by itself did not differentiate among which patients would develop MAKE; rather, the recovery pattern was more informative.”

The new findings, he said, “provide evidence for considering the timing of functional recovery from AKI as a factor associated with future adverse events.”

Dr Mehta also noted that “it is clear that clinicians managing patients with AKI should consider the severity of the disease and the ensuing course and tailor their diagnostic and therapeutic interventions to facilitate rapid and complete recovery of kidney function.”

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References

Bhatraju PK, Zelnick LR, Chinchilli VM, et al. Association between early recovery of kidney function after acute kidney injury and long-term clinical outcomes. JAMA Netw Open. 2020;3(4):e202682. doi: 10.1001/jamanetworkopen.2020.2682

Mehta RL. Renal recovery after acute kidney injury and long-term outcomes: Is time of the essence? JAMA Netw Open. 2020;3(4):e202676. doi: 10.1001/jamanetworkopen.2020.2676