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

Michael Heung, Diane E. Steffick, Kara Zivin, Brenda W. Gillespie, Tanushree Banerjee, Chi yuan Hsu, Neil R. Powe, Meda E. Pavkov, Desmond E. Williams, Rajiv Saran, Vahakn B. Shahinian

Research output: Contribution to journalArticle

Abstract

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 > 60mL/min/1.73m2, 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 <60mL/min/1.73m2 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

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Mar 25 2015
Externally publishedYes

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Veterans Health
United States Department of Veterans Affairs
Chronic Renal Insufficiency
Acute Kidney Injury
Kidney
Glomerular Filtration Rate
Creatinine
Chronic Kidney Failure
Inpatients
Dialysis
Outpatients
Retrospective Studies
Transplantation
Wounds and Injuries
Serum

Keywords

  • Acute kidney injury (AKI)
  • Acute on chronic kidney disease
  • AKI outcomes
  • Chronic kidney disease (CKD)
  • Kidney function
  • Recovery speed
  • Renal complications
  • Renal recovery
  • Serum creatinine
  • Veterans Administration (VA)

ASJC Scopus subject areas

  • Nephrology

Cite this

Heung, M., Steffick, D. E., Zivin, K., Gillespie, B. W., Banerjee, T., Hsu, C. Y., ... Shahinian, V. B. (Accepted/In press). Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2015.10.019

Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD : An Analysis of Veterans Health Administration Data. / Heung, Michael; Steffick, Diane E.; Zivin, Kara; Gillespie, Brenda W.; Banerjee, Tanushree; Hsu, Chi yuan; Powe, Neil R.; Pavkov, Meda E.; Williams, Desmond E.; Saran, Rajiv; Shahinian, Vahakn B.

In: American Journal of Kidney Diseases, 25.03.2015.

Research output: Contribution to journalArticle

Heung, M, Steffick, DE, Zivin, K, Gillespie, BW, Banerjee, T, Hsu, CY, Powe, NR, Pavkov, ME, Williams, DE, Saran, R & Shahinian, VB 2015, 'Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data', American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2015.10.019
Heung, Michael ; Steffick, Diane E. ; Zivin, Kara ; Gillespie, Brenda W. ; Banerjee, Tanushree ; Hsu, Chi yuan ; Powe, Neil R. ; Pavkov, Meda E. ; Williams, Desmond E. ; Saran, Rajiv ; Shahinian, Vahakn B. / Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD : An Analysis of Veterans Health Administration Data. In: American Journal of Kidney Diseases. 2015.
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abstract = "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 > 60mL/min/1.73m2, 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 <60mL/min/1.73m2 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",
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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.

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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 > 60mL/min/1.73m2, 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 <60mL/min/1.73m2 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

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 > 60mL/min/1.73m2, 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 <60mL/min/1.73m2 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

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