Predicting Risk of Recurrent Acute Kidney Injury: A Systematic Review

Abstract

Background: Although the epidemiology of acute kidney injury (AKI) has been well described, less is known about recurrent AKI (r-AKI). We undertook a systematic review to identify incidence, risk factors, and outcomes of r-AKI. Methods: MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science were searched, from inception to December 2017, for quantitative studies on adults with AKI, where follow-up included ­reporting of r-AKI. Two reviewers independently identified studies and assessed study quality. Summary: From 2,824 citations, 10 cohort studies met inclusion criteria (total patients n = 538,667). There were 2 distinct set of studies; 4 studies assessed r-AKI within the same hospital admission (most were intensive care unit [ICU] patients) and 6 studies assessed postdischarge r-AKI. The median percentage of people developing r-AKI within the same hospital admission was 23.4% (IQR 20.3–27.2%) and postdischarge r-AKI was 31.3% (IQR 26.4–33.7%). A higher Acute Physiology and Chronic Health Evaluation score was associated with increased risk of r-AKI within the same hospital admission in ICU patients. Cardiovascular disease and AKI severity were associated with increased risk of postdischarge r-AKI. R-AKI (within same admission and postdischarge) was associated with worse survival. It was not possible to pool results due to methodological differences across studies, such as varying definitions for AKI and r-AKI, varying length of follow-up and effect measures. Key messages: More representative population-based studies with robust assessment of predictors and consensus definition of r-AKI are needed to identify risk factors and develop risk stratification tools to reduce recurrence and improve outcomes. Systematic Review Registration: CRD42017082668.

Long-Term Outcomes in Patients with Acute Kidney Injury

“…A number of other clinically relevant outcomes have been reported to occur more frequently following AKI. Further episodes of AKI are more likely in AKI survivors, and they are independently associated with higher risk of subsequent CKD and ESKD (11)(12)(13)(14). AKI is associated with risk of hospital readmission, of which a leading cause is pulmonary edema/heart failure; this risk is seen in the first 90 days and persists to 5 years (9,10).…”

“…Its associations with short-term morbidity and mortality are well recognized, representing a major health care burden, with even small or transient declines in kidney function associating with serious adverse outcomes (4). In parallel, long-term outcomes in AKI survivors have become a major area of interest, with a burgeoning number of studies reporting links between AKI and the development or progression of CKD (5,6), longerterm mortality (5,7), cardiovascular events (8), hospital readmissions (9,10), recurrent AKI (11)(12)(13)(14), and poorer quality of life (15). Despite this, there are no established therapeutic interventions to reduce post-AKI sequelae or evidence to inform strategies for health care provision.…”

Exercise as a therapeutic option for acute kidney injury: mechanisms and considerations for the design of future clinical studies

“…This definition recognises the renal impairment that persists beyond the definition of AKI and prior to CKD. Furthermore, AKI can worsen underlying CKD [6]; over 30% of patients suffer repeated episodes of AKI [7] which in turn can further increase a patient's CKD and ESKD risk. It is estimated that CKD occurs in approximately 25% of AKI survivors [8].…”

Retrospective Analysis of Mortality Cases in Advanced and Metastatic Solid Tumors With Concurrent Prerenal Azotemia

“…Half of our cases developed AKI due to other complications, such as septicemia or infection. As recurrent AKI is common in patients who have already been hospitalized with AKI, and because AKI is associated with an increased rate of death (21,22), there is a need for clinicians to quickly identify risk factors and generate appropriate management plans (18). Increased production of inflammatory cytokines can result in thromboembolic complications, cancer cachexia, and tumor progression, which result in poor prognoses (11,12).…”