Abstract
BackgroundAcute kidney injury (AKI) and chronic kidney disease (CKD) are common syndromes associated with significant morbidity, mortality and cost. The extent to which repeated AKI episodes may cumulatively affect the rate of progression of all-cause CKD has not previously been investigated. In this study, we explored the hypothesis that repeated episodes of AKI increase the rate of renal functional deterioration loss in patients recruited to a large, all-cause CKD cohort.MethodsPatients from the Salford Kidney Study (SKS) were considered. Application of KDIGO criteria to all available laboratory measurements of renal function identified episodes of AKI. A competing risks model was specified for four survival events: Stage 1 AKI; stage 2 or 3 AKI; dialysis initiation or transplant before AKI event; death before AKI event. The model was adjusted for patient age, gender, smoking status, alcohol intake, diabetic status, cardiovascular co-morbidities, and primary renal disease. Analyses were performed for patients’ first, second, and third or more AKI episodes.ResultsA total of 48,338 creatinine measurements were available for 2287 patients (median 13 measures per patient [IQR 6–26]). There was a median age of 66.8years, median eGFR of 28.4 and 31.6% had type 1 or 2 diabetes. Six hundred and forty three (28.1%) patients suffered one or more AKI events; 1000 AKI events (58% AKI 1) in total were observed over a median follow-up of 2.6 years [IQR 1.1–3.2]. In patients who suffered an AKI, a second AKI was more likely to be a stage 2 or 3 AKI than stage 1 [HR 2.04, p 0.01]. AKI events were associated with progression to RRT, with multiple episodes of AKI progressively increasing likelihood of progression to RRT [HR 14.4 after 1 episode of AKI, HR 28.4 after 2 episodes of AKI]. However, suffering one or more AKI events was not associated with an increased risk of mortality.ConclusionsAKI events are associated with more rapid CKD deterioration as hypothesised, and also with a greater severity of subsequent AKI. However, our study did not find an association of AKI with increased mortality risk in this CKD cohort.
Highlights
Acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent syndromes that are based on the same spectrum
AKI events are associated with more rapid CKD deterioration as hypothesised, and with a greater severity of subsequent AKI
Our study did not find an association of AKI with increased mortality risk in this CKD cohort
Summary
Acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent syndromes that are based on the same spectrum. Both AKI and CKD are associated with significant morbidity, mortality and Healthcare cost.[1,2,3] AKI has an incidence of 12–18% in recent United Kingdom (UK) studies of hospitalized patients.[4,5] Occurrence was associated with subsequent longer in-patient stays, and with over 40,000 deaths per annum.[4] The cost of treating AKI is estimated at 1% of the annual NHS budget, more than £1 billion annually.[4]. We explored the hypothesis that repeated episodes of AKI increase the rate of renal functional deterioration loss in patients recruited to a large, allcause CKD cohort
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