Epidemiology and Outcomes of Acute Kidney Diseases: A Comparative Analysis

Abstract

<b><i>Introduction:</i></b> Acute kidney diseases and disorders (AKD) encompass acute kidney injury (AKI) and subacute or persistent alterations in kidney function that occur after an initiating event. Unlike AKI, accurate estimates of the incidence and prognosis of AKD are not available and its clinical significance is uncertain. <b><i>Methods:</i></b> We studied the epidemiology and long-term outcome of AKD (as defined by the KDIGO criteria), with or without AKI, in a retrospective cohort of adults hospitalized at a single centre for >24 h between 2012 and 2016 who had a baseline eGFR ≥60 mL/min/1.73 m<sup>2</sup> and were alive at 30 days. In patients for whom follow-up data were available, the risks of major adverse kidney events (MAKEs), CKD, kidney failure, and death were examined by Cox and competing risk regression analyses. <b><i>Results:</i></b> Among 62,977 patients, 906 (1%) had AKD with AKI and 485 (1%) had AKD without AKI. Follow-up data were available for 36,118 patients. In this cohort, compared to no kidney disease, AKD with AKI was associated with a higher risk of MAKEs (40.25 per 100 person-years; hazard ratio [HR] 2.51, 95% confidence interval [CI] 2.16–2.91), CKD (27.84 per 100 person-years); subhazard ratio [SHR] 3.18, 95% CI 2.60–3.89), kidney failure (0.56 per 100 person-years; SHR 24.84, 95% CI 5.93–104.03), and death (14.86 per 100 person-years; HR 1.52, 95% CI 1.20–1.92). Patients who had AKD without AKI also had a higher risk of MAKEs (36.21 per 100 person-years; HR 2.26, 95% CI 1.89–2.70), CKD (22.94 per 100 person-years; SHR 2.69, 95% CI 2.11–3.43), kidney failure (0.28 per 100 person-years; SHR 12.63, 95% CI 1.48–107.64), and death (14.86 per 100 person-years; HR 1.57, 95% CI 1.19–2.07). MAKEs after AKD were driven by CKD, especially in the first 3 months. <b><i>Conclusions:</i></b> These findings establish the burden and poor prognosis of AKD and support prioritisation of clinical initiatives and research strategies to mitigate such risk.

Acute Kidney Disease After Acute Decompensated Heart Failure

“… 38 According to previous studies, the incidence of AKD in patients without an identified AKI episode is 17% to 37.8%. 39 , 40 , 41 , 42 Our study revealed that approximately 40% and 20% of patients with AKI and patients without AKI developed AKD after ADHF, respectively.…”

“…Both AKI and AKI severity are associated with AKD development 38 . According to previous studies, the incidence of AKD in patients without an identified AKI episode is 17%-37.8% [39][40][41][42] . Our study showed that approximately 40% and 20% of AKI patients and non-AKI patients developed AKD after ADHF, respectively.…”

Reflections on the KDIGO Definition of Acute Kidney Injury and Its Integration in the Concept of Acute Diseases and Disorders and Chronic Kidney Diseases

“…Interestingly, a comparison of the primary composite outcomes of incident CKD, kidney failure, or death between hospitalized patients with AKD without AKI and patients with AKD post-AKI, the latter defined by the ADQI definition, was recently published [95]. Compared with no AKD, both groups with AKD showed similar hazard ratios for the primary outcomes.…”

Severe acute kidney disease is associated with worse kidney outcome among acute kidney injury patients

“…A large population-based observational study discovered a statistically significant association between AKD and major adverse kidney events (MAKEs) related to CKD progression, ESKD, and mortality 10 . With or without AKI, AKD was also found to be associated with adverse clinical outcome among hospitalized patients 11 .…”

“…Nevertheless, the disparate definitions of AKD might indicate variance in the acuity and severity of kidney disease among different subgroups of AKD patients 12 . Persistent kidney dysfunction for more than 7 days after AKI (post-AKI AKD) is associated with adverse renal and cardiovascular outcomes 11 , 13 – 17 . The 16th Acute Disease Quality Initiative (ADQI) recommends definitions and staging criteria for post-AKI AKD and renal recovery, but the clinical trajectories of renal function after AKI and the prognostic value of AKD staging remain largely unknown 2 , 18 .…”