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Epidemiology, Incidence, Risk Factors, and Outcomes of Acute Kidney Injury

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Core Concepts in Acute Kidney Injury

Abstract

Acute kidney injury (AKI) affects between 7 and 22% of patients in hospital and >50% of patients in the intensive care unit (ICU). The exact incidence and outcome depend on patient characteristics, pre-existing comorbidities and severity of acute illness. Typical risk factors for AKI are age, pre-existing chronic kidney disease (CKD), proteinuria, left ventricular dysfunction, liver disease and a previous episode of AKI. The most common exposures known to produce AKI in susceptible patients include sepsis, major surgery and nephrotoxic drugs. Patients with AKI have five times greater odds of dying compared to those without AKI. Mortality increases stepwise with severity of AKI.

Survivors of AKI are at risk of significant long-term complications, including CKD, progression to end-stage renal disease (ESRD), cardiovascular events, stroke, infections, fractures and premature mortality. The reasons are multifactorial and include patient-related factors like pre-existing comorbidities but also factors directly related to AKI per se. Progressive CKD, in particular, has been recognised as a major long-term health problem following AKI. The risk is particularly high in patients with pre-existing chronic comorbidities and those with more severe and more prolonged AKI. It appears that processes involved in the pathophysiology and recovery from AKI play an important role. These include cell cycle arrest, mitochondrial dysregulation, maladaptive repair, recruitment of infiltrating inflammatory and stem cells, capillary rarefication, glomerular hyperfiltration and activation of myofibroblasts and fibrocytes.

Further in-depth research is urgently required to identify the key factors and potential therapeutic interventions.

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Author information

Authors and Affiliations

  1. Department of Nephrology and Critical Care Medicine, King’s College London, Guy’s & St Thomas’ Foundation Hospital, London, UK

    Marlies Ostermann

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  1. Marlies Ostermann
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Correspondence to Marlies Ostermann .

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Editors and Affiliations

  1. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sushrut S. Waikar

  2. University College Dublin, Dublin, Ireland

    Patrick T. Murray

  3. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ajay K. Singh

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Ostermann, M. (2018). Epidemiology, Incidence, Risk Factors, and Outcomes of Acute Kidney Injury. In: Waikar, S., Murray, P., Singh, A. (eds) Core Concepts in Acute Kidney Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-8628-6_1

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  • DOI: https://doi.org/10.1007/978-1-4939-8628-6_1

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  • Print ISBN: 978-1-4939-8626-2

  • Online ISBN: 978-1-4939-8628-6

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