Abstract
IntroductionAcute kidney injury (AKI) is common among intensive care unit (ICU) patients, but follow-up data on subsequent risk of cardiovascular disease remain sparse. We examined the impact of AKI on three-year risk of first-time heart failure, myocardial infarction (MI), and stroke among ICU patients surviving to hospital discharge, and whether this risk is modified by renal recovery before hospital discharge.MethodsWe used population-based medical registries to identify all adult patients admitted to an ICU in Northern Denmark between 2005 and 2010 who survived to hospital discharge and who had no previous or concurrent diagnosis of heart failure, MI, or stroke. AKI was defined according to the creatinine criteria in the Kidney Disease Improving Global Outcomes classification. We computed the three-year cumulative risk of hospitalization with heart failure, MI, and stroke for patients with and without AKI and the hazard ratios (HRs), using a Cox model adjusted for potential confounders.ResultsAmong 21,556 ICU patients surviving to hospital discharge, 4,792 (22.2%) had an AKI episode. Three-year cumulative risk of heart failure was 2.2% in patients without AKI, 5.0% for AKI stage 1, and 5.0% for stages 2 to 3. The corresponding adjusted HRs were 1.33 (95% confidence interval (CI), 1.06 to 1.66) for patients with AKI stage 1 and 1.45 (95% CI, 1.14 to 1.84) for AKI stages 2 to 3, compared to patients without AKI. The three-year cumulative MI risk was 1.0% for patients without AKI, 1.8% for patients with AKI stage 1 and 2.3% for patients with AKI stages 2 to 3. The adjusted HR for MI was 1.04 (95% CI, 0.71 to 1.51) for patients with AKI stage 1 and 1.51 (95% CI, 1.05 to 2.18) for patients with AKI stages 2 to 3, compared with patients without AKI. We found no association between AKI and stroke. The increased risk of heart failure and MI persisted in patients with renal recovery before discharge, although it was less pronounced than in patients without renal recovery.ConclusionsICU patients surviving any stage of AKI are at increased three-year risk of heart failure, but not stroke. Only AKI stages 2 to 3 are associated with increased MI risk.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0492-2) contains supplementary material, which is available to authorized users.
Highlights
Acute kidney injury (AKI) is common among intensive care unit (ICU) patients, but follow-up data on subsequent risk of cardiovascular disease remain sparse
Characteristics of the study population The study population comprised 21,556 ICU patients who survived to hospital discharge, after excluding those with a previous kidney transplant or chronic dialysis treatment (n = 314), those with a previous or concurrent diagnosis of heart failure (HF), myocardial infarction (MI), or stroke (n = 6,702), and those lacking a plasma creatinine measurement upon or after ICU admission (n = 1,846)
We found that 4,792 (22.2%) of the 21,556 ICU patients had an episode of AKI; 2,666 (12.4%) with AKI stage 1 and 2,126 (9.9%) with AKI stages 2 to 3
Summary
Acute kidney injury (AKI) is common among intensive care unit (ICU) patients, but follow-up data on subsequent risk of cardiovascular disease remain sparse. The potentially increased risk of cardiovascular disease following AKI might be mediated through These findings are supported by a few cohort studies in humans, which reported that patients with AKI as a complication to myocardial infarction (MI), coronary intervention, or heart failure (HF) have an increased risk of subsequent HF and MI [13,14,15,16,17,18]. AKI during hospitalization increases the risk of subsequent HF in patients infected with human immunodeficiency virus (HIV) [19]. It has been suggested that AKI may increase stroke risk [20], the potential association between AKI and long-term stroke risk has received little attention [13]
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