Modification of outcomes after acute kidney injury by the presence of CKD

Neesh Pannu, Matthew James, Brenda R. Hemmelgarn, Jianghu Dong, Marcello Tonelli, Scott Klarenbach

Research output: Contribution to journalArticlepeer-review

54 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume58
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

Keywords

  • Acute kidney injury
  • chronic kidney disease
  • epidemiology
  • outcomes

ASJC Scopus subject areas

  • Nephrology

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