TY - JOUR
T1 - Modification of outcomes after acute kidney injury by the presence of CKD
AU - Pannu, Neesh
AU - James, Matthew
AU - Hemmelgarn, Brenda R.
AU - Dong, Jianghu
AU - Tonelli, Marcello
AU - Klarenbach, Scott
N1 - Funding Information:
A complete list of the membership of the AKDN Network can be found at www.AKDN.info . Additional statistical support was provided by Phoebe Ye.
PY - 2011/8
Y1 - 2011/8
N2 - Background: Acute kidney injury (AKI) in hospitalized patients is associated with poor outcomes; however, it is unclear how relationships between AKI and clinical outcomes vary with baseline kidney function. Study Design: Population-based cohort. Setting & Participants: Adults in Alberta, Canada, who were hospitalized between January 1, 2003, and December 31, 2006, with at least 1 serum creatinine measurement during hospitalization and 1 outpatient creatinine measurement within 6 months preceding admission. Predictor: Baseline kidney function, defined as mean estimated glomerular filtration rate (eGFR) of all outpatient creatinine measurements within 6 months before the index hospitalization, and AKI, defined using consensus criteria. Outcomes: Death during the index hospitalization and death or end-stage renal disease (ESRD) after hospitalization. Results: AKI occurred in 18.3% of the 43,008 hospitalized patients in the cohort. Risk of AKI increased with decreasing eGFR (8.9% with eGFR <60 mL/min/1.73 m 2 vs 68.9% with eGFR <30 mL/min/1.73 m 2). In multivariable Cox models, AKI of any severity was associated with death during the index hospitalization across all levels of eGFR, with an HR of 2.99 (95% CI, 2.59-3.44) in patients who had the least severe AKI across all eGFR strata up to an HR of 10.62 (95% CI, 8.78-12.82) in patients with baseline eGFR >60 mL/min/1.73 m 2 and the most severe AKI. The risk of death or ESRD decreased after discharge, with the highest risk of ESRD after AKI noted in patients with eGFR <30 mL/min/1.73 m 2 (17.0% in the AKI group vs 5.6% in the non-AKI group; P < 0.01). Limitations: The study cohort is restricted to patients who had outpatient serum creatinine values available. Conclusions: AKI of any severity increases the risk of death both during hospitalization and after discharge. Although the risk of developing ESRD after AKI is greatest in patients with baseline eGFR <30 mL/min/1.73 m 2, this is exceeded by the risk of death.
AB - Background: Acute kidney injury (AKI) in hospitalized patients is associated with poor outcomes; however, it is unclear how relationships between AKI and clinical outcomes vary with baseline kidney function. Study Design: Population-based cohort. Setting & Participants: Adults in Alberta, Canada, who were hospitalized between January 1, 2003, and December 31, 2006, with at least 1 serum creatinine measurement during hospitalization and 1 outpatient creatinine measurement within 6 months preceding admission. Predictor: Baseline kidney function, defined as mean estimated glomerular filtration rate (eGFR) of all outpatient creatinine measurements within 6 months before the index hospitalization, and AKI, defined using consensus criteria. Outcomes: Death during the index hospitalization and death or end-stage renal disease (ESRD) after hospitalization. Results: AKI occurred in 18.3% of the 43,008 hospitalized patients in the cohort. Risk of AKI increased with decreasing eGFR (8.9% with eGFR <60 mL/min/1.73 m 2 vs 68.9% with eGFR <30 mL/min/1.73 m 2). In multivariable Cox models, AKI of any severity was associated with death during the index hospitalization across all levels of eGFR, with an HR of 2.99 (95% CI, 2.59-3.44) in patients who had the least severe AKI across all eGFR strata up to an HR of 10.62 (95% CI, 8.78-12.82) in patients with baseline eGFR >60 mL/min/1.73 m 2 and the most severe AKI. The risk of death or ESRD decreased after discharge, with the highest risk of ESRD after AKI noted in patients with eGFR <30 mL/min/1.73 m 2 (17.0% in the AKI group vs 5.6% in the non-AKI group; P < 0.01). Limitations: The study cohort is restricted to patients who had outpatient serum creatinine values available. Conclusions: AKI of any severity increases the risk of death both during hospitalization and after discharge. Although the risk of developing ESRD after AKI is greatest in patients with baseline eGFR <30 mL/min/1.73 m 2, this is exceeded by the risk of death.
KW - Acute kidney injury
KW - chronic kidney disease
KW - epidemiology
KW - outcomes
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U2 - 10.1053/j.ajkd.2011.01.028
DO - 10.1053/j.ajkd.2011.01.028
M3 - Article
C2 - 21496979
AN - SCOPUS:79960844321
SN - 0272-6386
VL - 58
SP - 206
EP - 213
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -