Three-year outcomes after acute kidney injury: results of a prospective parallel group cohort study

Kerry L Horne, Rebecca Packington, John Monaghan, Timothy Reilly, Nicholas M Selby, Kerry L Horne, Rebecca Packington, John Monaghan, Timothy Reilly, Nicholas M Selby

Abstract

Objectives: Using a prospective study design, we aimed to characterise the effect of acute kidney injury (AKI) on long-term changes in renal function in a general hospital population.

Participants: Hospitalised patients with AKI (exposed) and hospitalised patients without AKI (non-exposed), recruited at 3 months after hospital admission.

Design: Prospective, matched parallel group cohort study, in which renal function and proteinuria were measured at 3 months, 1 year and 3 years.

Setting: Single UK centre.

Clinical end points: Clinical end points at 3 years were comparison of the following variables between exposed and non-exposed groups: renal function, prevalence of proteinuria and albuminuria and chronic kidney disease (CKD) progression/development at each time point. CKD progression was defined as a decrease in the estimated glomerular filtration rate (eGFR) of ≥25% associated with a decline in eGFR stage.

Results: 300 exposed and non-exposed patients were successfully matched 1:1 for age and baseline renal function; 70% of the exposed group had AKI stage 1. During follow-up, the AKI group had lower eGFR than non-exposed patients at each time point. At 3 years, the mean eGFR was 60.7±21 mL/min/1.73 m2 in the AKI group compared with 68.4±21 mL/min/1.73 m2 in the non-exposed group, p=0.003. CKD development or progression at 3 years occurred in 30 (24.6%) of the AKI group compared with 10 (7.5%) of the non-exposed group, p<0.001. Albuminuria was more common in the AKI group, and increased with AKI severity. Factors independently associated with CKD development/progression after AKI were non-recovery at 90 days, male gender, diabetes and recurrent AKI.

Conclusions: AKI is associated with deterioration in renal function to 3 years, even in an unselected population with predominantly AKI stage 1. Non-recovery from AKI is an important factor determining long-term outcome.

Keywords: AKI; Acute Kidney Injury; Albuminuria; CKD; Chronic Kidney Disease; E-alerts.

Conflict of interest statement

Competing interests: NMS has previously received speaker honoraria from Amgen and Baxter.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Mean estimated glomerular filtration rate (eGFR) at each assessment point in non-exposed (no acute kidney injury (AKI)) compared with matched participants with AKI. Estimated GFR measurements are included for inhospital time points to illustrate the effect of AKI; however, the absolute eGFR values at these time points should be interpreted with caution as patients are not in steady state. *p

Figure 3

Mean estimated glomerular filtration rate…

Figure 3

Mean estimated glomerular filtration rate (eGFR) over time in individuals after acute kidney…

Figure 3
Mean estimated glomerular filtration rate (eGFR) over time in individuals after acute kidney injury (AKI) with and without chronic kidney disease progression. Estimated GFR measurements are included for inhospital time points to illustrate the effect of AKI; however, the absolute eGFR values at these time points should be interpreted with caution as patients are not in steady state. Error bars: 95% CI. *p
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References
    1. Susantitaphong P, Cruz DN, Cerda J et al. . World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol 2013;8:1482–93. 10.2215/CJN.00710113 - DOI - PMC - PubMed
    1. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012;81:442–8. 10.1038/ki.2011.379 - DOI - PMC - PubMed
    1. Go AS, Parikh CR, Ikizler TA et al. . The assessment, serial evaluation, and subsequent sequelae of acute kidney injury (ASSESS-AKI) study: design and methods. BMC Nephrol 2010;11:22 10.1186/1471-2369-11-22 - DOI - PMC - PubMed
    1. Horne KL, Packington R, Monaghan J et al. . The effects of acute kidney injury on long-term renal function and proteinuria in a general hospitalised population. Nephron Clin Pract 2014;128:192–200. 10.1159/000368243 - DOI - PubMed
    1. Selby NM, Crowley L, Fluck RJ et al. . Use of electronic results reporting to diagnose and monitor AKI in hospitalized patients. Clin J Am Soc Nephrol 2012;7:533–40. 10.2215/CJN.08970911 - DOI - PubMed
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Figure 3
Figure 3
Mean estimated glomerular filtration rate (eGFR) over time in individuals after acute kidney injury (AKI) with and without chronic kidney disease progression. Estimated GFR measurements are included for inhospital time points to illustrate the effect of AKI; however, the absolute eGFR values at these time points should be interpreted with caution as patients are not in steady state. Error bars: 95% CI. *p

References

    1. Susantitaphong P, Cruz DN, Cerda J et al. . World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol 2013;8:1482–93. 10.2215/CJN.00710113
    1. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012;81:442–8. 10.1038/ki.2011.379
    1. Go AS, Parikh CR, Ikizler TA et al. . The assessment, serial evaluation, and subsequent sequelae of acute kidney injury (ASSESS-AKI) study: design and methods. BMC Nephrol 2010;11:22 10.1186/1471-2369-11-22
    1. Horne KL, Packington R, Monaghan J et al. . The effects of acute kidney injury on long-term renal function and proteinuria in a general hospitalised population. Nephron Clin Pract 2014;128:192–200. 10.1159/000368243
    1. Selby NM, Crowley L, Fluck RJ et al. . Use of electronic results reporting to diagnose and monitor AKI in hospitalized patients. Clin J Am Soc Nephrol 2012;7:533–40. 10.2215/CJN.08970911
    1. Venkatachalam MA, Griffin KA, Lan R et al. . Acute kidney injury: a springboard for progression in chronic kidney disease. Am J Physiol Renal Physiol 2010;298:F1078–94. 10.1152/ajprenal.00017.2010
    1. Wynn TA. Fibrosis under arrest. Nat Med 2010;16:523–5. 10.1038/nm0510-523
    1. Mammen C, Al Abbas A, Skippen P et al. . Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 2012;59:523–30. 10.1053/j.ajkd.2011.10.048
    1. Greenberg JH, Coca S, Parikh CR. Long-term risk of chronic kidney disease and mortality in children after acute kidney injury: a systematic review. BMC Nephrol 2014;15:184 10.1186/1471-2369-15-184
    1. Li L, Astor BC, Lewis J et al. . Longitudinal progression trajectory of GFR among patients with CKD. Am J Kidney Dis 2012;59:504–12. 10.1053/j.ajkd.2011.12.009
    1. Omotoso BA, Abdel-Rahman EM, Xin W et al. . Acute kidney injury (AKI) outcome, a predictor of long-term major adverse cardiovascular events (MACE). Clin Nephrol 2016;85:1–11. 10.5414/CN108671
    1. Chawla LS, Eggers PW, Star RA et al. . Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 2014;371:58–66. 10.1056/NEJMra1214243
    1. Chawla LS, Amdur RL, Amodeo S et al. . The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 2011;79:1361–9. 10.1038/ki.2011.42
    1. Thakar CV, Christianson A, Himmelfarb J et al. . Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol 2011;6:2567–72. 10.2215/CJN.01120211
    1. Schmitt R, Coca S, Kanbay M et al. . Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 2008;52:262–71. 10.1053/j.ajkd.2008.03.005
    1. D'Hoore E, Neirynck N, Schepers E et al. . Chronic kidney disease progression is mainly associated with non-recovery of acute kidney injury. J Nephrol 2015;28:709–16. 10.1007/s40620-015-0181-5
    1. Jones J, Holmen J, De Graauw J et al. . Association of complete recovery from acute kidney injury with incident CKD stage 3 and all-cause mortality. Am J Kidney Dis 2012;60:402–8. 10.1053/j.ajkd.2012.03.014
    1. Hsu CY, Hsu RK, Yang J et al. . Elevated BP after AKI. J Am Soc Nephrol 2016;27:914–23. 10.1681/ASN.2014111114
    1. Gallagher M, Cass A, Bellomo R et al. . Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med 2014;11:e1001601 10.1371/journal.pmed.1001601
    1. Askenazi DJ, Feig DI, Graham NM et al. . 3–5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int 2006;69:184–9. 10.1038/sj.ki.5000032
    1. Russo LM, Sandoval RM, McKee M et al. . The normal kidney filters nephrotic levels of albumin retrieved by proximal tubule cells: retrieval is disrupted in nephrotic states. Kidney Int 2007;71:504–13. 10.1038/sj.ki.5002041
    1. Horne KL, Shardlow A, Taal MW et al. . Long term outcomes after acute kidney injury: lessons from the ARID Study. Nephron 2015;131:102–6. 10.1159/000439066
    1. Smith ER, Cai MMX, McMahon LP et al. . The value of simultaneous measurements of urinary albumin and total protein in proteinuric patients. Nephrol Dial Transplant 2012;27:1534–41. 10.1093/ndt/gfr708

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