TY - JOUR
T1 - Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD
T2 - An Analysis of Veterans Health Administration Data
AU - Centers for Disease Control and Prevention CKD Surveillance Team
AU - Heung, Michael
AU - Steffick, Diane E.
AU - Zivin, Kara
AU - Gillespie, Brenda W.
AU - Banerjee, Tanushree
AU - Hsu, Chi Yuan
AU - Powe, Neil R.
AU - Pavkov, Meda E.
AU - Williams, Desmond E.
AU - Saran, Rajiv
AU - Shahinian, Vahakn B.
N1 - Funding Information:
Support: This project was supported under a cooperative agreement from the CDC , grant U58DP003836 . The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or VA. Drs Pavkov and Williams are employed by the sponsor and had roles in study design and execution as co-authors on this manuscript. This work was supported in part with resources and the use of facilities at the VA Ann Arbor Healthcare Center.
Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background 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 Retrospective cohort. Setting & Participants 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 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 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 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 Most patients' 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 Variable timing of follow-up and mostly male veteran cohort may limit generalizability. Conclusions 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.
AB - Background 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 Retrospective cohort. Setting & Participants 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 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 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 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 Most patients' 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 Variable timing of follow-up and mostly male veteran cohort may limit generalizability. Conclusions 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.
KW - AKI outcomes
KW - Index Words Renal recovery
KW - Veterans Administration (VA)
KW - acute kidney injury (AKI)
KW - acute on chronic kidney disease
KW - chronic kidney disease (CKD)
KW - kidney function
KW - recovery speed
KW - renal complications
KW - serum creatinine
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U2 - 10.1053/j.ajkd.2015.10.019
DO - 10.1053/j.ajkd.2015.10.019
M3 - Article
C2 - 26690912
AN - SCOPUS:84949845196
SN - 0272-6386
VL - 67
SP - 742
EP - 752
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -