Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality
Journal
Kidney International
Journal Volume
80
Journal Issue
11
Pages
1222-1230
Date Issued
2011
Author(s)
Chih-Chung Shiao
Pei-Chen Wu
Tze-Wah Kao
Guang-Huar Young
Pi-Ru Tsai
Chieh-Li Wang
Ming-Shou Wu
Fu-Chang Hu
Wen-Je Ko
Abstract
Existing chronic kidney disease (CKD) is among the most potent predictors of postoperative acute kidney injury (AKI). Here we quantified this risk in a multicenter, observational study of 9425 patients who survived to hospital discharge after major surgery. CKD was defined as a baseline estimated glomerular filtration rate <45 ml/min per 1.73 m2. AKI was stratified according to the maximum simplified RIFLE classification at hospitalization and unresolved AKI defined as a persistent increase in serum creatinine of more than half above the baseline or the need for dialysis at discharge. A Cox proportional hazard model showed that patients with AKI-on-CKD during hospitalization had significantly worse long-term survival over a median follow-up of 4.8 years (hazard ratio, 3.3) than patients with AKI but without CKD. The incidence of long-term dialysis was 22.4 and 0.17 per 100 person-years among patients with and without existing CKD, respectively. The adjusted hazard ratio for long-term dialysis in patients with AKI-on-CKD was 19.8 compared to patients who developed AKI without existing CKD. Furthermore, AKI-on-CKD but without kidney recovery at discharge had a worse outcome (hazard ratios of 4.6 and 213, respectively) for mortality and long-term dialysis as compared to patients without CKD or AKI. Thus, in a large cohort of postoperative patients who developed AKI, those with existing CKD were at higher risk for long-term mortality and dialysis after hospital discharge than those without. These outcomes were significantly worse in those with unresolved AKI at discharge. ? 2011 International Society of Nephrology.
SDGs
Other Subjects
creatinine; acute kidney failure; adult; aged; article; chronic kidney failure; cohort analysis; controlled study; creatinine blood level; dialysis; disease association; disease course; female; follow up; glomerulus filtration rate; hazard ratio; high risk patient; hospital discharge; human; incidence; kidney surgery; long term care; major clinical study; male; mortality; multicenter study; outcome assessment; overall survival; priority journal; proportional hazards model; renal replacement therapy; risk assessment
Publisher
Nature Publishing Group
Type
journal article