Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data

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• 作者：Michael Heung ; MD ; MS¹ ; ^{mheung@umich.edu" class="auth_mail" title="E-mail the corresponding author} ; Diane E. Steffick ; PhD¹ ; Kara Zivin ; PhD² ; ³ ; Brenda W. Gillespie ; PhD¹ ; Tanushree Banerjee ; PhD⁴ ; Chi-yuan Hsu ; MD ; MSc⁴ ; Neil R. Powe ; MD⁴ ; Meda E. Pavkov ; MD ; PhD⁵ ; Desmond E. Williams ; MD ; PhD⁵ ; Rajiv Saran ; MD¹ ; ^&lowast ; ; Vahakn B. Shahinian ; MD¹ ; ^&lowast ; ; on behalf of the Centers for Disease Control ; Prevention CKD Surveillance Team^&dagger ; ; Rajiv Saran (Principal Investigator) ; Yi Li ; Jennifer Bragg-Gresham ; Vahakn Shahinian ; Hal Morgenstern ; Michael Heung ; Diane Steffick ; Anca Tilea ; Brenda Gillespie ; William Herman ; Jerry Yee ; Kara Zivin ; William McClellan ; Deb Gipson ; Sai Dharmarajan ; Rajesh Balkrishnan ; April Wyncott ; Neil Powe (Principal Investigator) ; Tanushree Banerjee ; Chi-yuan Hsu ; Kirsten Bibbins-Domingo ; Deidra Crews ; Vanessa Grubbs ; Delphine Tuot ; Yunno Zhu ; Nilka R&iacute ; os Burrows (Technical Advisor) ; Desmond Williams ; Mark Eberhardt ; Paul Eggers ; Meda Pavkov ; Deborah Rolka ; Sharon Saydah ; Larry Waller
• 关键词：Renal recovery ; acute kidney injury (AKI) ; AKI outcomes ; chronic kidney disease (CKD) ; acute on chronic kidney disease ; kidney function ; serum creatinine ; renal complications ; recovery speed ; Veterans Administration (VA)
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：67
• 期：5
• 页码：742-752
• 全文大小：513 K

文摘

Studies suggest an association between acute kidney injury (AKI) and long-term risk for chronic kidney disease (CKD), even following apparent renal recovery. Whether the pattern of renal recovery predicts kidney risk following AKI is unknown.

Study Design

ra0015">Retrospective cohort.

Setting & Participants

ra0020">Patients in the Veterans Health Administration in 2011 hospitalized (>24 hours) with at least 2 inpatient serum creatinine measurements, baseline estimated glomerular filtration rate > 60 mL/min/1.73 m², and no diagnosis of end-stage renal disease or non−dialysis-dependent CKD: 17,049 (16.3%) with and 87,715 without AKI.

Predictor

ra0025">Pattern of recovery to creatinine level within 0.3 mg/dL of baseline after AKI: within 2 days (fast), in 3 to 10 days (intermediate), and no recovery by 10 days (slow or unknown).

Outcome

ra0030">CKD stage 3 or higher, defined as 2 outpatient estimated glomerular filtration rates < 60 mL/min/1.73 m² at least 90 days apart or CKD diagnosis, dialysis therapy, or transplantation.

Measurements

ra0035">Risk for CKD was modeled using modified Poisson regression and time to death-censored CKD was modeled using Cox proportional hazards regression, both stratified by AKI stage.

Results

ra0040">Most patients&rsquo; AKI episodes were stage 1 (91%) and 71% recovered within 2 days. At 1 year, 18.2% had developed CKD (AKI, 31.8%; non-AKI, 15.5%; P < 0.001). In stage 1, the adjusted relative risk ratios for CKD stage 3 or higher were 1.43 (95% CI, 1.39-1.48), 2.00 (95% CI, 1.88-2.12), and 2.65 (95% CI, 2.51-2.80) for fast, intermediate, and slow/unknown recovery. A similar pattern was observed in subgroup analyses incorporating albuminuria and sensitivity analysis of death-censored time to CKD.

Limitations

ra0045">Variable timing of follow-up and mostly male veteran cohort may limit generalizability.

Conclusions

ra0050">Patients who develop AKI during a hospitalization are at substantial risk for the development of CKD by 1 year following hospitalization and timing of AKI recovery is a strong predictor, even for the mildest forms of AKI.