Association of Complete Recovery From Acute Kidney Injury With Incident CKD Stage 3 and All-Cause Mortality

Jones, Jason P.; Holmén, John; Graauw, Jennifer De; Jovanovich, Anna; Thornton, Sid; Chonchol, Michel

doi:10.1053/j.ajkd.2012.03.014

Cited by 189 publications

(149 citation statements)

References 19 publications

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“…Patients who developed AKI were more likely to develop CKD by 3.3 years compared with matched control patients who did not develop AKI (hazard ratio 1.9). The same result was observed in a larger cohort study of 3,809 patients with normal baseline renal function, in which AKI was associated with a higher risk of CKD at 2.5 years (hazard ratio by propensity score-stratified analysis, 3.82, 95% CI 2.81-5.19) [39]. It cannot be determined from either of these observational studies whether AKI caused CKD or whether the association of AKI with subsequent CKD is due to common risk factors [40].…”

Section: Case Discussionsupporting

confidence: 76%

Renal Involvement in Paroxysmal Nocturnal Hemoglobinuria

2013

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Renal involvement in paroxysmal nocturnal hemoglobinuria (PNH) is not usually apparent but in cases with clinical involvement varies from reversible acute dysfunction to chronic irreversible damage. Early diagnosis and treatment is crucial to prevent disease progression and irreversible chronic kidney disease (CKD). The ultimate outcome of CKD in many patients is the need for renal replacement therapy, which necessitates ever-growing dialysis and transplantation programs, thereby imposing a significant economic burden on the healthcare system. In a third-world country like Pakistan, increased burden due to CKD can be very hard on families. Doctor visits, hospitalization, and dialysis are all out-of-pocket expenses, therefore prevention, early detection, and timely intervention are the only cost-effective strategies. We report a case of acute kidney injury (AKI) due to PNH. This case shows AKI as one of the complications of PNH which may have a clinical course like acute tubular necrosis (ATN). This could be due to ATN or AKI superimposed on CKD due to hemosiderin deposits in the renal tubular epithelial cells. Our patient was dialyzed initially and discharged with a permanent catheter in place with advice to continue dialysis three times a week. He required dialysis for 1 week then started producing urine. His subsequent outpatient visits showed improved renal function. The permanent catheter was removed and maintenance dialysis was stopped. Here, we briefly review the literature on renal involvement in PNH, treatment options for PNH and pigment-induced nephropathy followed by a question-and-answer session at the clinicopathological conference held on March 4, 2011, at Sindh Institute of Urology and Transplantation in Karachi, Pakistan.

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Section: Case Discussionsupporting

confidence: 76%

Renal Involvement in Paroxysmal Nocturnal Hemoglobinuria

2013

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“…Less data exists on patients who seem to recover baseline renal function after AKI. Our analysis suggests that many of these patients may have unrecognized CKD, findings that are supported by studies showing increased rates of later CKD after apparent recovery from AKI in adults (28,29) and children (30).…”

Section: Relation To Previous Studiessupporting

confidence: 73%

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

Prowle

Kolic²,

Purdell-Lewis³

et al. 2014

Clinical Journal of the American Society of Nephrology

141

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Background and objectives AKI is a risk factor for development or worsening of CKD. However, diagnosis of renal dysfunction by serum creatinine could be confounded by loss of muscle mass and creatinine generation after critical illness.Design, setting, participants, & measurements A retrospective, single center analysis of serum in patients surviving to hospital discharge with an intensive care unit admission of 5 or more days between 2009 and 2011 was performed.Results In total, 700 cases were identified, with a 66% incidence of AKI. In 241 patients without AKI, creatinine was significantly lower (P,0.001) at hospital discharge than admission (median, 0.61 versus 0.88 mg/dl; median decrease, 33%). In 160 patients with known baseline, discharge creatinine was significantly lower than baseline in all patients except those patients with severe AKI (Kidney Disease Improving Global Outcomes category 3), who had no significant difference. In a multivariable regression model, median duration of hospitalization was associated with a predicted 30% decrease (95% confidence interval, 8% to 45%) in creatinine from baseline in the absence of AKI; after allowing for this effect, AKI was associated with a 29% (95% confidence interval, 10% to 51%) increase in predicted hospital discharge creatinine. Using a similar model to exclude the confounding effect of prolonged major illness on creatinine, 148 of 700 patients (95% confidence interval, 143 to 161) would have eGFR,60 ml/min per 1.73 m 2 at hospital discharge compared with only 63 of 700 patients using eGFR based on unadjusted hospital creatinine (a 135% increase in potential CKD diagnoses; P,0.001).Conclusion Critical illness is associated with significant falls in serum creatinine that persist to hospital discharge, potentially causing inaccurate assessment of renal function at discharge, particularly in survivors of AKI. Prospective measurements of GFR and creatinine generation are required to confirm the significance of these findings.

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“…[48][49][50] Causes of AKI vary geographically. The causes for AKI in the developed world regions include imagining contrast, surgery, toxicity from medications, critical illness, and complications to chronic diseases, such as cardiac and liver disease.…”

Section: Ckd Progressionmentioning

confidence: 99%

Maintenance Dialysis throughout the World in Years 1990 and 2010

Thomas

Wulf

Bikbov

et al. 2015

Journal of the American Society of Nephrology

173

137

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Rapidly rising global rates of chronic diseases portend a consequent rise in ESRD. Despite this, kidney disease is not included in the list of noncommunicable diseases (NCDs) targeted by the United Nations for 25% reduction by year 2025. In an effort to accurately report the trajectory and pattern of global growth of maintenance dialysis, we present the change in prevalence and incidence from 1990 to 2010. Data were extracted from the Global Burden of Disease 2010 epidemiologic database. The results are on the basis of an analysis of data from worldwide national and regional renal disease registries and detailed systematic literature review for years 1980-2010. Incidence and prevalence estimates of provision of maintenance dialysis from this database were updated using a negative binomial Bayesian metaregression tool for 187 countries. Results indicate substantial growth in utilization of maintenance dialysis in almost all world regions. Changes in population structure, changes in aging, and the worldwide increase in diabetes mellitus and hypertension explain a significant portion, but not all, of the increase because increased dialysis provision also accounts for a portion of the rise. These findings argue for the importance of inclusion of kidney disease among NCD targets for reducing premature death throughout the world.

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Association of Complete Recovery From Acute Kidney Injury With Incident CKD Stage 3 and All-Cause Mortality

Cited by 189 publications

References 19 publications

Renal Involvement in Paroxysmal Nocturnal Hemoglobinuria

Renal Involvement in Paroxysmal Nocturnal Hemoglobinuria

Serum Creatinine Changes Associated with Critical Illness and Detection of Persistent Renal Dysfunction after AKI

Maintenance Dialysis throughout the World in Years 1990 and 2010

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