Long-term Risk of Mortality and End-Stage Renal Disease Among the Elderly After Small Increases in Serum Creatinine Level During Hospitalization for Acute Myocardial Infarction

Abstract

Background: Although small changes in creatinine level during hospitalization have been associated with risk of short-term mortality, associations with posthospitalization end-stage renal disease (ESRD) and long-term mortality are unknown. We assessed the relationship between change in serum creatinine levels up to 3.0 mg/dL and death and ESRD among elderly survivors of hospitalization for acute myocardial infarction. Methods: Retrospective cohort study of a nationally representative sample of Medicare beneficiaries admitted with acute myocardial infarction to nonfederal US hospitals between February 1994 and July 1995. Outcomes were mortality and ESRD through June 2004. Results: The 87 094 eligible patients admitted to 4473 hospitals had a mean age of 77.1 years; for the 43.2% with some creatinine increase, quartiles of increase were 0.1, 0.2, 0.3 to 0.5, and 0.6 to 3.0 mg/dL. Incidence of ESRD and mortality ranged from 2.3 and 139.1 cases per 1000 person-years, respectively, among patients with no increase to 20.0 and 274.9 cases per 1000 person-years in the highest quartile of creatinine increase. Compared with patients without creatinine increase, adjusted hazard ratios by quartile of increase were 1.45, 1.97, 2.36, and 3.26 for ESRD and 1.14, 1.16, 1.26, and 1.39 for mortality, with no 95% confidence intervals overlapping 1.0 for either end point. Conclusion: In a nationally representative sample of elderly patients discharged after hospitalization for acute myocardial infarction, small changes in serum creatinine level during hospitalization were associated with an independent higher risk of ESRD and death.

Long‐term Outcome of Patients Treated With Prophylactic Nesiritide for the Prevention of Acute Kidney Injury Following Cardiovascular Surgery

“…23,24 The long-term mortality rate in this study (∼20%) is in accord with published data in patients undergoing CV surgery 18 -26 and may be linked to the associated excess comorbidities, toxicities, and adverse pathobiological states that accelerate cardiovascular damage. 27 Consistent with data from other studies, 8,13,14 patients with AKI following cardiac surgery had reduced long-term cumulative survival compared to those with no AKI, and this was irrespective of nesiritide status. Although the nesiritide group had a lower incidence of postoperative AKI in the Nesiritide Study, this did not translate into long-term survival benefit.…”

“…7,12 In fact, AKI has been reported to increase the risk for ESRD, 13,14 and even small changes in SCr level during hospitalization were associated with an independent higher risk of ESRD and death. 8 In CV surgery patients, deterioration of immediate postoperative renal function has been reported to predict in-hospital mortality and longterm survival. 15 In view of these observations, ascertaining the long-term effects of the observed renoprotection by nesiritide in the immediate postoperative period following CV surgery in the Nesiritide Study is of interest.…”

“…Small changes in SCr during hospitalization have been reported to predict long-term mortality and risk for end-stage renal disease (ESRD) requiring dialysis treatment. 7,8 Therefore, we investigated whether the observed renal benefits of nesiritide in the immediate postoperative period had any long-term impact on the incidence of mortality or requirement for dialysis.…”

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…As the evidence linking AKI with loss of kidney function [45][46][47][77][78][79][80] , hypertension 81,82 , cardiovascular disease 49,50,83 , and death 46,[83][84][85][86][87] accumulates, determining the optimal care for this growing population is critical. The American Society of Nephrology AKI Advisory Group has highlighted the transition of care as a potential opportunity to reduce the long-term impact of AKI 88 , and hence, AKD.…”

Review article: Acute kidney injury in critical illness

“…This broad range is attributable to differences in the definition of AKI, the observed time-at-risk, and the selected risk profile of included patients. In both acute decompensated heart failure and acute coronary syndrome; however, the development of AKI portends a greater short-and long-term risk of all-cause and cardiovascular mortality, prolonged duration of hospitalization, 57-61 increased readmission rates, 62,63 accelerated progression to advanced CKD, 64 and higher health care costs. 59 In addition, there is a biological gradient between AKI severity and mortality.…”