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Kidney Int. 2018 Feb;93(2):460-469. doi: 10.1016/j.kint.2017.07.007. Epub 2017 Sep 18.

Acute kidney injury is a risk factor for subsequent proteinuria.

Author information

1
Geriatric Research Education and Clinical Center, Tennessee Valley Health System Veterans Administration Medical Center, Nashville, Tennessee, USA; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease and Vanderbilt Integrated Program for AKI Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
2
Geriatric Research Education and Clinical Center, Tennessee Valley Health System Veterans Administration Medical Center, Nashville, Tennessee, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
3
Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease and Vanderbilt Integrated Program for AKI Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
4
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
5
Geriatric Research Education and Clinical Center, Tennessee Valley Health System Veterans Administration Medical Center, Nashville, Tennessee, USA.
6
Geriatric Research Education and Clinical Center, Tennessee Valley Health System Veterans Administration Medical Center, Nashville, Tennessee, USA; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
7
Geriatric Research Education and Clinical Center, Tennessee Valley Health System Veterans Administration Medical Center, Nashville, Tennessee, USA; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease and Vanderbilt Integrated Program for AKI Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: edward.siew@vanderbilt.edu.

Abstract

Acute kidney injury (AKI) is associated with subsequent chronic kidney disease (CKD), but the mechanism is unclear. To clarify this, we examined the association of AKI and new-onset or worsening proteinuria during the 12 months following hospitalization in a national retrospective cohort of United States Veterans hospitalized between 2004-2012. Patients with and without AKI were matched using baseline demographics, comorbidities, proteinuria, estimated glomerular filtration rate, blood pressure, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEI/ARB) use, and inpatient exposures linked to AKI. The distribution of proteinuria over one year post-discharge in the matched cohort was compared using inverse probability sampling weights. Subgroup analyses were based on diabetes, pre-admission ACEI/ARB use, and AKI severity. Among the 90,614 matched AKI and non-AKI pairs, the median estimated glomerular filtration rate was 62 mL/min/1.73m2. The prevalence of diabetes and hypertension were 48% and 78%, respectively. The odds of having one plus or greater dipstick proteinuria was significantly higher during each month of follow-up in patients with AKI than in patients without AKI (odds ratio range 1.20-1.39). Odds were higher in patients with Stage II or III AKI (odds ratios 1.32-1.81) than in Stage I AKI (odds ratios 1.18-1.32), using non-AKI as the reference group. Results were consistent regardless of diabetes status or baseline ACEI/ARB use. Thus, AKI is a risk factor for incident or worsening proteinuria, suggesting a possible mechanism linking AKI and future CKD. The type of proteinuria, physiology, and clinical significance warrant further study as a potentially modifiable risk factor in the pathway from AKI to CKD.

KEYWORDS:

acute kidney injury; albuminuria; proteinuria

PMID:
28927644
PMCID:
PMC5796522
DOI:
10.1016/j.kint.2017.07.007
[Indexed for MEDLINE]
Free PMC Article

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