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Nephron. 2019;142(2):83-90. doi: 10.1159/000497385. Epub 2019 Mar 21.

Predicting Risk of Recurrent Acute Kidney Injury: A Systematic Review.

Author information

1
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom, H.O.Hounkpatin@soton.ac.uk.
2
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
3
Department of Health Sciences, University of York, York, United Kingdom.
4
Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
5
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, United Kingdom.
6
Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
7
National Institute for Health Research (NIHR) Leeds In Vitro Diagnostic Cooperative, Leeds, United Kingdom.

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.

KEYWORDS:

Acute renal injury; Epidemiology; Prognosis; Recurrence

PMID:
30897569
DOI:
10.1159/000497385
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