Abstract
BackgroundSurvivors of acute kidney injury are at an increased risk of developing irreversible deterioration in kidney function and in some cases, the need for chronic dialysis. We aimed to determine predictors of chronic dialysis and death among survivors of dialysis-requiring acute kidney injury.MethodsWe used linked administrative databases in Ontario, Canada, to identify patients who were discharged from hospital after an episode of acute kidney injury requiring dialysis and remained free of further dialysis for at least 90 days after discharge between 1996 and 2009. Follow-up extended until March 31, 2011. The primary outcome was progression to chronic dialysis. Predictors for this outcome were evaluated using cause-specific Cox proportional hazards models, and a competing risk approach was used to calculate absolute risk.ResultsWe identified 4 383 patients with acute kidney injury requiring temporary in-hospital dialysis who survived to discharge. After a mean follow-up of 2.4 years, 356 (8%) patients initiated chronic dialysis and 1475 (34%) died. The cumulative risk of chronic dialysis was 13.5% by the Kaplan-Meier method, and 10.3% using a competing risk approach. After accounting for the competing risk of death, previous nephrology consultation (subdistribution hazard ratio (sHR) 2.03; 95% confidence interval (CI) 1.61-2.58), a history of chronic kidney disease (sHR3.86; 95% CI 2.99-4.98), a higher Charlson comorbidity index score (sHR 1.10; 95% CI 1.05-1.15/per unit) and pre-existing hypertension (sHR 1.82; 95% CI 1.28-2.58) were significantly associated with an increased risk of progression to chronic dialysis.ConclusionsAmong survivors of dialysis-requiring acute kidney injury who initially become dialysis independent, the subsequent need for chronic dialysis is predicted by pre-existing kidney disease, hypertension and global comorbidity. This information can identify patients at high risk of progressive kidney disease who may benefit from closer surveillance after cessation of the acute phase of illness.
Highlights
Survivors of acute kidney injury are at an increased risk of developing irreversible deterioration in kidney function and in some cases, the need for chronic dialysis
Characteristics of study participants We identified 4 383 patients with a previous episode of Acute kidney injury (AKI)-D who survived to 90 days following hospital discharge with no reinitiation of dialysis. (Figure 1) Mean age was 61 (±16) years, 60% were male and 28% had seen
As demonstrated by Chawla et al, we found that hypertension was another important predictor of chronic dialysis among AKI-D survivors [25]
Summary
Survivors of acute kidney injury are at an increased risk of developing irreversible deterioration in kidney function and in some cases, the need for chronic dialysis. We aimed to determine predictors of chronic dialysis and death among survivors of dialysis-requiring acute kidney injury. Acute kidney injury (AKI) is a common and serious complication of hospitalization; in severe cases, urgent renal replacement therapy (hereafter referred to as dialysis) is needed to address complications of AKI and to support the patient in overcoming the acute illness. AKI guidelines to recommended that kidney function should be evaluated 3 months after an AKI episode to establish the presence and extent of chronic kidney disease [6] others have advocated that Nephrology follow-up occur for all patients with severe AKI [7]. In a cohort of AKI-D survivors, we performed a study to determine the predictors of permanent maintenance dialysis and secondarily, death
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