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Am J Kidney Dis. 2011 Aug;58(2):206-13. doi: 10.1053/j.ajkd.2011.01.028. Epub 2011 Apr 15.

Modification of outcomes after acute kidney injury by the presence of CKD.

Author information

1
Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada. npannu@ualberta.ca

Abstract

BACKGROUND:

Acute kidney injury (AKI) in hospitalized patients is associated with poor outcomes; however, it is unclear how relationships between AKI and clinical outcomes vary with baseline kidney function.

STUDY DESIGN:

Population-based cohort.

SETTING & PARTICIPANTS:

Adults in Alberta, Canada, who were hospitalized between January 1, 2003, and December 31, 2006, with at least 1 serum creatinine measurement during hospitalization and 1 outpatient creatinine measurement within 6 months preceding admission.

PREDICTOR:

Baseline kidney function, defined as mean estimated glomerular filtration rate (eGFR) of all outpatient creatinine measurements within 6 months before the index hospitalization, and AKI, defined using consensus criteria.

OUTCOMES:

Death during the index hospitalization and death or end-stage renal disease (ESRD) after hospitalization.

RESULTS:

AKI occurred in 18.3% of the 43,008 hospitalized patients in the cohort. Risk of AKI increased with decreasing eGFR (8.9% with eGFR ≥60 mL/min/1.73 m(2) vs 68.9% with eGFR <30 mL/min/1.73 m(2)). In multivariable Cox models, AKI of any severity was associated with death during the index hospitalization across all levels of eGFR, with an HR of 2.99 (95% CI, 2.59-3.44) in patients who had the least severe AKI across all eGFR strata up to an HR of 10.62 (95% CI, 8.78-12.82) in patients with baseline eGFR >60 mL/min/1.73 m(2) and the most severe AKI. The risk of death or ESRD decreased after discharge, with the highest risk of ESRD after AKI noted in patients with eGFR <30 mL/min/1.73 m(2) (17.0% in the AKI group vs 5.6% in the non-AKI group; P < 0.01).

LIMITATIONS:

The study cohort is restricted to patients who had outpatient serum creatinine values available.

CONCLUSIONS:

AKI of any severity increases the risk of death both during hospitalization and after discharge. Although the risk of developing ESRD after AKI is greatest in patients with baseline eGFR <30 mL/min/1.73 m(2), this is exceeded by the risk of death.

PMID:
21496979
DOI:
10.1053/j.ajkd.2011.01.028
[Indexed for MEDLINE]
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