The severity of acute kidney injury predicts progression to chronic kidney disease

Abstract

Acute kidney injury (AKI) is associated with progression to advanced chronic kidney disease (CKD). We tested whether patients who survive AKI and are at higher risk for CKD progression can be identified during their hospital admission, thus providing opportunities to intervene. This was assessed in patients in the Department of Veterans Affairs Healthcare System hospitalized with a primary diagnosis indicating AKI (ICD9 codes 584.xx). In the exploratory phase, three multivariate prediction models for progression to stage 4 CKD were developed. In the confirmatory phase, the models were validated in 11,589 patients admitted for myocardial infarction or pneumonia during the same time frame that had RIFLE codes R, I, or F and complete data for all predictor variables. Of the 5351 patients in the AKI group, 728 entered stage 4 CKD after hospitalization. Models 1, 2, and 3 were all significant with ‘c' statistics of 0.82, 0.81, and 0.77, respectively. In model validation, all three were highly significant when tested in the confirmatory patients, with moderate to large effect sizes and good predictive accuracy (‘c' 0.81–0.82). Patients with AKI who required dialysis and then recovered were at especially high risk for progression to CKD. Hence, the severity of AKI is a robust predictor of progression to CKD.

Severity and Frequency of Proximal Tubule Injury Determines Renal Prognosis

“…We also clarified that the severity and frequency of proximal tubule injury underlies the degree of AKI to CKD progression. [9][10][11][12] The reversibility of fibrosis after the regeneration of proximal tubules was shown with mild proximal tubule injury, and the presence of proximal-distal tubule crosstalk was confirmed. Our data strongly support the importance of protecting proximal tubules to halt AKI to CKD progression.…”

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

“…5). For example, patients who have more severe or persistent AKD 11,96 , those with premorbid conditions that increase the risk of future CKD progression (for example, those with evidence of pre-existing CKD, diabetes and/or proteinuria), and those with recurrent disease or non-recovery (for example, those with congestive heart failure, cirrhosis, and/or malignancy with or without chemotherapy) might achieve greater benefit from earlier or more frequent surveillance than patients with a lower risk of future CKD 97,98 . This hypothesis is supported by data showing that rates of re-hospitalization and recurrent AKI are high among patients with similar risk factors 95,[98][99][100][101][102][103][104] .…”

Acute kidney injury in children with sickle cell disease—compounding a chronic problem

“…In addition, several adult studies have demonstrated a dose-response relationship between AKI and CKD, including a higher risk of CKD in those with more severe AKI and also in those with repeated episodes of AKI [35][36][37]. Several pediatric observational studies have also shown a high proportion of CKD in survivors of AKI, ranging from 10 to 69%, but these studies have focused on populations without primary kidney disease [38][39][40][41][42][43][44].…”