Outcomes of acute kidney injury in a nephrology ward

  • Ana R. Fernandes
  • Márcio S. R. Viegas
  • Elsa Q. Soares
  • Sofia S. Coelho
  • Patricia Valério
  • José C. Barreto
  • José M. Vinhas
Nephrology - Original Paper

Abstract

Acute kidney injury (AKI) is a global problem which predicts immediate and long-term adverse outcomes. We evaluated the AKI progression to end-stage renal disease, as well as the mortality associated with AKI and the in-hospital readmission rate because of a cardiovascular event in AKI patients admitted in a nephrology ward. A 5-year retrospective study was set in a nephrology department, with a follow-up period of up to 8 years. In a total of 191 patients, mean age was 73.83 ± 12.49 years, and 137 (71.7%) patients had history of chronic kidney disease. One hundred and twenty-four (65%) patients needed RRT and two (1%) needed surgery. Upon discharge, 107 (56%) patients had recovered the renal function, 41 (21.6%) patients had partial recovery, 25 (13%) patients were RRT dependent, 16 (8.4%) died, and two (1%) patients had outcomes unknown to us, because they were transferred to other hospitals. The median survival time free of RRT was 74 months. The median survival time of the followed patients was 34 months (95% CI 23.3–44.7). The mortality rate in the follow-up period in this sample was 18 deaths/100 patients-years, and the incidence of a composite cardiovascular endpoint of heart failure, acute coronary syndrome, and stroke was 6 events/100 patients-years. The mortality rate in the follow-up period was higher than usually described for patients outside intensive care unit, probably because our patients were old and had many comorbidities.

Keywords

Acute kidney injury End-stage renal disease Mortality Cardiovascular disease 

References

  1. 1.
    Kidney Disease: Improving Global Out-Comes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1–138CrossRefGoogle Scholar
  2. 2.
    Hsu CY, McCullough CE, Fan D, Ordonez JD, Cherow GM, Go AS (2007) Community-based incidence of acute renal failure. Kidney Int 72:208–212CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Brady HR, Singer GG (1995) Acute renal failure. Lancet 346:1533–1540CrossRefPubMedGoogle Scholar
  4. 4.
    Hilton R (2006) Acute renal failure. BMJ 333:786–790CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM (2006) Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol 17:1143–1150CrossRefPubMedGoogle Scholar
  6. 6.
    Pôncio L, Balbi AL, Rocha ÉP et al (2015) The long-term outcome after acute kidney injury: a narrative review. J Bras Nefrol 37(1):115–120CrossRefPubMedGoogle Scholar
  7. 7.
    James MT, Ghali WA, Knudtson ML et al (2011) Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography. Circulation 123:409–416CrossRefPubMedGoogle Scholar
  8. 8.
    Schmitt R et al (2008) Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 52:262–271CrossRefPubMedGoogle Scholar
  9. 9.
    Wu VC et al (2011) Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Kidney Int 80:1222–1230CrossRefPubMedGoogle Scholar
  10. 10.
    Hsu CY et al (2009) Nonrecovery of kidney function and death after acute on chronic renal failure. Clin J Am Soc Nephrol 4:891–898CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M et al (2005) Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care 9:R700–R709CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Korkeila M, Ruokonen E, Takala J (2000) Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med 26:1824–1831CrossRefPubMedGoogle Scholar
  13. 13.
    Triverio PA, Martin PY, Romand J, Pugin J, Perneger T, Saudan P (2009) Long-term prognosis after acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant 24:2186–2189CrossRefPubMedGoogle Scholar
  14. 14.
    Tsagalis G, Akrivos T, Alevizaki M, Manios E, Theodorakis M, Laggouranis A et al (2009) Long-term prognosis of acute kidney injury after first acute stroke. Clin J Am Soc Nephrol 4:616–622CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Silvester W, Bellomo R, Cole L (2001) Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 29:1910–1915CrossRefPubMedGoogle Scholar
  16. 16.
    Thakar CV, Christianson A, Himmelfarb J, Leonard AC (2011) Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol 6:2567–2572CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bhandari S, Turney JH (1996) Survivors of acute renal failure who do not recover renal function. QJM 89(6):415–421CrossRefPubMedGoogle Scholar
  18. 18.
    Manhes G, Heng AE, Aublet-Cuvelier B, Gazuy N, Deteix P, Souweine B (2005) Clinical features and outcome of chronic dialysis patients admitted to an intensive care unit. Nephrol Dial Transplant 20:1127–1133CrossRefPubMedGoogle Scholar
  19. 19.
    Srisawat N, Murugan R, Lee M, Kong L, Carter M, Angus DC et al (2011) Genetic and inflammatory markers of sepsis (GenIMS) study investigators. Plasma neutrophil gelatinase-associated lipocalin predicts recovery from acute kidney injury following community-acquired pneumonia. Kidney Int 80:545–552CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Wald R, Quinn RR, Adhikari NK, Burns KE, Friedrich JO, Garg AX et al (2012) University of Toronto Acute Kidney Injury Research Group. Risk of chronic dialysis and death following acute kidney injury. Am J Med 125:585–593CrossRefPubMedGoogle Scholar
  21. 21.
    Coca SG, Singanamala S, Parikh CR (2012) Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 81(5):442–448CrossRefPubMedGoogle Scholar
  22. 22.
    Rennie TJ, Patton A, Dreischulte T et al (2016) Incidence and outcomes of acute kidney injury requiring renal replacement therapy: a retrospective cohort study. Nephron 133(4):239–246CrossRefPubMedGoogle Scholar
  23. 23.
    Hickson LJ, Chaudhary S, Williams AW et al (2015) Predictors of outpatient kidney function recovery among patients who initiate hemodialysis in the hospital. Am J Kidney Dis 65(4):592–602CrossRefPubMedGoogle Scholar
  24. 24.
    Sprenger-Mähr H, Zitt E, Lhotta K (2016) Acute kidney injury treated with dialysis outside the intensive care unit: a retrospective observational single-center study. PLoS ONE 11(9):e0163512CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ruiz-Criado J, Ramos-Barron MA, Fernandez-Fresnedo G et al (2015) Long-term mortality among hospitalized non-ICU patients with acute kidney injury referred to nephrology. Nephron 131(1):23–33CrossRefPubMedGoogle Scholar
  26. 26.
    Sawhney S, Marks A, Fluck N et al (2017) Intermediate and long-term outcomes of survivors of acute kidney injury episodes: a large population-based cohort study. Am J Kidney Dis 69(1):18–28CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lindeman RD, Goldman R (1986) Anatomic and physiologic age changes in the kidney. Exp Gerontol 21(4–5):379–406CrossRefPubMedGoogle Scholar
  28. 28.
    McLachlan MS, Guthrie JC, Anderson CK, Fulker MJ (1977) Vascular and glomerular changes in the ageing kidney. J Pathol 121(2):65–78CrossRefPubMedGoogle Scholar
  29. 29.
    Darmady EM, Offer J, Woodhouse MA (1973) The parameters of the ageing kidney. J Pathol 109(3):195–207CrossRefPubMedGoogle Scholar
  30. 30.
    Tauchi H, Tsuboi K, Okutomi J (1971) Age changes in the human kidney of the different races. Gerontologia 17(2):87–97CrossRefPubMedGoogle Scholar
  31. 31.
    Hollenberg NK, Adams DF, Solomon HS, Rashid A, Abrams HL, Merrill JP (1974) Senescence and the renal vasculature in normal man. Circ Res 34(3):309–316CrossRefPubMedGoogle Scholar
  32. 32.
    Davies DF, Shock NW (1950) Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J Clin Invest 29(5):496–507CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Lindeman RD, Tobin J, Shock NW (1985) Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 33(4):278–285CrossRefPubMedGoogle Scholar
  34. 34.
    Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW (1976) The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 31(2):155–163CrossRefPubMedGoogle Scholar
  35. 35.
    Reckelhoff JF, Manning RD (1993) Role of endothelium-derived nitric oxide in control of renal microvasculature in aging male rats. Am J Physiol 265(5 pt 2):R1126–R1131PubMedGoogle Scholar
  36. 36.
    Rowe JW, Shock NW, DeFronzo RA (1976) The influence of age on the renal response to water deprivation in man. Nephron 17(4):270–278CrossRefPubMedGoogle Scholar
  37. 37.
    Qiao X, Chen X, Wu D et al (2005) Mitochondrial pathway is responsible for aging-related increase of tubular cell apoptosis in renal ischemia/reperfusion injury. J Gerontol A Biol Sci Med Sci 60(7):830–839CrossRefPubMedGoogle Scholar
  38. 38.
    Chou JS, Reiser IW, Porush JG (1997) Aging and urinary excretion of epidermal growth factor. Ann Clin Lab Sci 27(2):116–122PubMedGoogle Scholar
  39. 39.
    Tran KT, Rusu SD, Satish L, Wells A (2003) Aging-related attenuation of EGF receptor signaling is mediated in part by increased protein tyrosine phosphatase activity. Exp Cell Res 289(2):359–367CrossRefPubMedGoogle Scholar
  40. 40.
    Xu X, Bennett SA, Ingram RL, Sonntag WE (1995) Decreases in growth hormone receptor signal transduction contribute to the decline in insulin-like growth factor I gene expression with age. Endocrinology 136(10):4551–4557CrossRefPubMedGoogle Scholar
  41. 41.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305CrossRefPubMedGoogle Scholar
  42. 42.
    Cho K, Hsu CY (2010) Quantifying severity of chronic kidney disease as a risk factor for acute kidney injury. J Am Soc Nephrol 21:1602–1604CrossRefPubMedGoogle Scholar
  43. 43.
    Lafrance JP, Djurdjev O, Levin A (2010) Incidence and outcomes of acute kidney injury in a referred chronic kidney disease cohort. Nephrol Dial Transplant 25:2203–2209CrossRefPubMedGoogle Scholar
  44. 44.
    Coca SG (2010) Acute kidney injury in elderly persons. Am J Kidney Dis 56(1):122–131CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Coca SG, Yusuf B, Shlipak MG et al (2009) Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53(6):961–973CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Odutayo A, Wong CX, Farkouh M et al (2017) AKI and long-term risk for cardiovascular events and mortality. J Am Soc Nephrol 28(1):377–387CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Serviço de Nefrologia do Centro Hospitalar de SetúbalSetúbalPortugal

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