Risk of Chronic Dialysis and Death Following Acute Kidney Injury

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• 作者：Ron Wald ; MDCM^a ; ^b ; ^waldr@smh.ca ; Robert R. Quinn ; MD^c ; Neill K. Adhikari ; MDCM^d ; Karen E. Burns ; MD^b ; ^e ; Jan O. Friedrich ; MD^b ; ^e ; Amit X. Garg ; MD^f ; Ziv Harel ; MD^a ; Michelle A. Hladunewich ; MD^d ; ^g ; Jin Luo ; MD^h ; Muhammad Mamdani ; PharmD^b ; ⁱ ; Jeffrey Perl ; MD^a ; ^b ; Joel G. Ray ; MD^b ; ^j ; University of Toronto Acute Kidney Injury Research Group
• 关键词：Acute kidney injury ; Death ; End-stage renal disease
• 刊名：The American Journal of Medicine
• 出版年：2012
• 期刊代码：6_00029343
• 类别：med
• 出版时间：June, 2012
• 卷：125
• 期：6
• 页码：585-593
• 文件大小：991 K

摘要

Background

Acute kidney injury frequently arises within an acute care hospitalization. Outcomes among acute kidney injury survivors following hospital discharge are poorly documented.

Methods

We conducted a population-based cohort study between 1996 and 2006 of all adult patients in Ontario with acute kidney injury who did not require in-hospital dialysis, and who survived free of dialysis 鈮?0 days after discharge. Those with acute kidney injury (n = 41,327) were matched 1:1 to patients without acute kidney injury during their index hospitalization. Matching was by age (卤1 year), sex, history of chronic kidney disease, receipt of mechanical ventilation during the index hospitalization, and a propensity score for developing acute kidney injury. The primary outcome was subsequent need for chronic dialysis. The secondary outcomes were all-cause mortality and rehospitalization.

Results

Mean age was 70 years, and median follow-up was 2 years (maximum 10 years). The incidence of chronic dialysis was 1.78 per 100 person-years among those with acute kidney injury and 0.74 per 100 person-years among unaffected controls (adjusted hazard ratio [HR]; 2.70, 95%confidence interval [CI], 2.42-3.00). Rates also were higher for all-cause mortality (15.34 vs 14.51 per-100 person-years; adjusted HR 1.10; 95%CI, 1.07-1.13) and rehospitalization (44.93 vs 37.18 per 100 person-years; adjusted HR 1.21; 95%CI, 1.18-1.24).

Conclusion

Even when acute dialysis is not required, survivors of acute kidney injury remain at higher risk of receipt of chronic dialysis thereafter. The absolute risk of death was more than 8 times the rate of chronic dialysis.