Predicting progression to chronic kidney disease after recovery from acute kidney injury

Abstract

This review examines the association between acute kidney injury (AKI) and subsequent risk for chronic kidney disease (CKD) development. The discussion focuses on patients who fully recover from an episode of AKI, the majority of whom do not receive follow-up care with nephrology services. Several studies have demonstrated a strong association between AKI and later CKD risk. Animal models provide evidence for a causal link between AKI and CKD while also elucidating some of the potential mechanisms for this progression. Large observational studies have quantified the risk of CKD following AKI recovery, and clinical and emerging biomarker risk factors have been identified. The association between AKI with incomplete recovery or nonrecovery and CKD is evident. Recent studies demonstrate that even AKI with apparent full recovery confers an increased risk for subsequent CKD development. Risk prediction models have been developed and require further refinement and validation. The ability to identify patients with AKI recovery who are at high risk for later CKD development is an important clinical and research goal, as there exists a significant opportunity to improve care in this population.