The severity of acute kidney injury (AKI) is a robust predictor of progression to chronic kidney disease (CKD), according to a new study published online in Kidney International.

In addition, investigators found that patients with AKI who required dialysis and then recovered were at especially high risk for progression to CKD.

Researchers led by Lakhmir S. Chawla, MD, of George Washington University Medical Center in Washington D.C., tested whether patients who survive AKI and are at higher risk for CKD progression could be identified during their hospital admission and thus provide opportunities to intervene. The team examined the records of 11,589 patients admitted for myocardial infarction (MI) or pneumonia. Among these patients, 5,351 patients had AKI and 728 entered stage 4 CKD.

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Advanced age, low serum albumin levels, the presence of diabetes, and severity of AKI were strong predictors of poor long-term renal outcome. The strong predictive value of serum albumin levels was a novel finding, but one that was not surprising because low serum albumin levels have been associated with poor outcomes in a variety of diseases, including end-stage renal disease, surgical illness, and acute stroke. Previously published studies have shown that low levels of serum albumin can be caused by nutritional related factors, high levels of inflammation or a combination of these factors.

The researchers developed and validated three equations to risk stratify those survivors of AKI who are at highest risk of CKD progression. “We propose that these equations be used for identification of patients who should receive additional follow-up and participate in interventional clinical trials,” the authors wrote.

These new findings confirm a recent meta-analysis showing that a higher proportion of elderly survivors of AKI did not recover renal function as well as younger control subjects (Am J Kidney Dis. 2007;49:517–523).