The risk of acute renal failure in patients with chronic kidney disease

Hsu, Chi‐yuan; Ordoñez, Juan D.; Chertow, Glenn M.; Fan, Dongjie; McCulloch, Charles E.; Go, Alan S.

doi:10.1038/ki.2008.107

Cited by 486 publications

(390 citation statements)

References 34 publications

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“…Proteinuria was first identified as a strong risk factor for AKI in 2008 (1). These observations were subsequently confirmed and extended in several other clinical scenarios and patient groups (2).…”

supporting

confidence: 56%

We Can Diagnose AKI “Early”

Hsu

2012

Clinical Journal of the American Society of Nephrology

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Proteinuria was first identified as a strong risk factor for AKI in 2008 (1). These observations were subsequently confirmed and extended in several other clinical scenarios and patient groups (2). Huang et al. showed that preoperative proteinuria was an independent risk factor for AKI after coronary artery bypass grafting (3). In this issue of the Clinical Journal of the American Society of Nephrology, two observational studies-both developed as part of the National Institutes of Health-sponsored Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) consortium-extend the association in the setting of cardiac surgery to postoperative proteinuria (4,5).Molnar and colleagues studied 1198 adult patients undergoing coronary artery bypass graft and/or valve surgery who were at high risk of AKI (including those with baseline creatinine level $ 2 mg/dl and age .70 years). They found that higher levels of urine albumin at approximately 6 hours after surgery measured by urine albumin concentrations or by urine dipstick levels (but not by urine albumin-to-creatine ratios) were associated with increased risk for postoperative AKI, defined as requiring dialysis or doubling of serum creatinine (4). Zappitelli and colleagues report that in a group of 294 children aged 1 month to 18 years undergoing cardiac surgery, postoperative urine albuminto-creatine ratio at about 6 hours after surgery predicts AKI on the basis of Acute Kidney Injury Network (AKIN) serum creatinine criteria, with greater prediction of lower stage AKI in children $2 years (5).Both studies are strengthened by their multicenter design, which enhances the generalizability of the findings, and by the careful and standardized prospective collection of clinical data and biospecimens in their participants. The investigators also took into account detailed patient and perioperative characteristics as part of their multivariate-adjusted models. The researchers for the adult study should be further commended because of the large sample and supplementary sensitivity analyses modifying the outcome to AKIN stage I and stage III AKI. These analyses allow us to see that the association between albuminuria and AKI remains fairly robust across gradations of AKI severity.Although the exact mechanisms underlying these associations are not known definitively, one can hypothesize that perhaps preoperative proteinuria identifies patients with underlying CKD and reduced renal reserve who are more susceptible to AKI, whereas postoperative proteinuria is an early reflection of renal parenchymal damage, the cause of the subsequent observed increase in serum creatinine. New and Old BiomarkersThese are important findings for the following reason. One oft-repeated mantra in the AKI field is that our failure thus far to devise effective therapies for most cases of AKI (specifically acute tubular necrosis) is due to an inability to detect AKI "early." The accompanying discussion sometimes makes it sound as if this were the predominant explanation for the lack of pr...

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supporting

confidence: 56%

We Can Diagnose AKI “Early”

Hsu

2012

Clinical Journal of the American Society of Nephrology

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“…high risk of cardiovascular diseases (CVD), acute renal injury, cognitive impairment, infections, and impaired physical function. [2][3][4][5][6] Anemia is a very common complication of CKD and is the result of interference of erythropoietin production. However, iron and vitamin deficiencies, blood loss, reduced erythrocyte life span, chronic inflammation, and uremic milieu are also the contributing factors for anemia in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Salman

Khan

Adnan

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Objective: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. Method: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. Results: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. Conclusion: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

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“…We explored this comparison because of the numerous shared patient risk factors across the spectrum of kidney diseases (such as older age and diabetes mellitus) and the knowledge that underlying CKD itself is a potent risk factor for AKI (20). Our data suggest that determinants of incidence of dialysis-requiring AKI are distributed in a geographically distinct fashion from shared risk factors for kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Regional Variation in the Incidence of Dialysis-Requiring AKI in the United States

Hsu¹,

McCulloch

Ku³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Little is known about geographic differences in the incidence of AKI. The objective of this study was to determine if regional variation exists in the population incidence of dialysis-requiring AKI in the United States.Design, setting, participants, & methods Data from the Nationwide Inpatient Sample, a US nationally representative sample of hospitalizations, were used to determine the incidence rates of dialysis-requiring AKI between 2007 and 2009 among the four US Census-designated regions. Cases were identified using validated discharge codes. Poisson regression models were used to estimate overall regional rates, accounting for the data's sampling scheme.Results In 2007-2009, the population incidence rates of dialysis-requiring AKI differed across the four Censusdesignated regions (P=0.04). Incidence was highest in the Midwest (523 cases/million person-yr, 95% confidence interval=483 to 568) and lowest in the Northeast (457 cases/million person-yr, 95% confidence interval=426 to 492). The pattern of regional variation in the incidence of dialysis-requiring AKI was not the same as the pattern of regional variation in the incidence of renal replacement therapy-requiring ESRD (obtained from the US Renal Data System). In-hospital mortality associated with dialysis-requiring AKI differed across the four regions, with the highest case fatality in the Northeast (25.9%) and the lowest case fatality in the Midwest (19.4%).Conclusions Significant regional variation exists in the population incidence of dialysis-requiring AKI in the United States, and additional investigation is warranted to uncover potential causes behind these geographic differences.

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The risk of acute renal failure in patients with chronic kidney disease

Cited by 486 publications

References 34 publications

We Can Diagnose AKI “Early”

We Can Diagnose AKI “Early”

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Regional Variation in the Incidence of Dialysis-Requiring AKI in the United States

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