Advertisement

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

  • Marlies Ostermann
Chapter

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.

Keywords

Acute kidney injury Outcome AKI CKD Risk factors Epidemiology 

References

  1. 1.
    Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int. 2012;2:1–138.CrossRefGoogle Scholar
  2. 2.
    Kellum JA, Sileanu FE, Murugan R, Lucko N, Shaw AD, Clermont G. Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol. 2015;26(9):2231–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ostermann M. Diagnosis of acute kidney injury: Kidney Disease Improving Global Outcomes criteria and beyond. Curr Opin Crit Care. 2014;20(6):581–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Thomas M, Blaine C, Dawnay A, et al. The definition of acute kidney injury and its use in practice. Kidney Int. 2015;87(1):62–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Endre ZH, Pickering JW. New markers of acute kidney injury: giant leaps and baby steps. Clin Biochem Rev. 2011;32(2):121–4.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. 2013;8(9):1482–93.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mehta RL, Burdmann EA, Cerda J, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet. 2016;387:2017–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Hoste E, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411–23.CrossRefGoogle Scholar
  9. 9.
    Wonnacott A, Meran S, Amphlett B, Talabani B, Phillips A. Epidemiology and outcomes in community-acquired versus hospital-acquired AKI. Clin J Am Soc Nephrol. 2014;9(6):1007–14.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Grams ME, Astor BC, Bash LD, Matsushita K, Wang Y, Coresh J. Albuminuria and estimated glomerular filtration rate independently associate with acute kidney injury. J Am Soc Nephrol. 2010;21(10):1757–64.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Varrier M, Ostermann M. Novel risk factors for acute kidney injury. Curr Opin Nephrol Hypertens. 2014;23:560–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Park SH, Shin WY, Lee EY, et al. The impact of hyperuricemia on in-hospital mortality and incidence of acute kidney injury in patients undergoing percutaneous coronary intervention. Circ J. 2011;75(3):692–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Wiedermann CJ, Wiedermann W, Joannidis M. Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies. Intensive Care Med. 2010;36(10):1657–65.CrossRefPubMedGoogle Scholar
  14. 14.
    Kumar AB, Bridget Zimmerman M, Suneja M. Obesity and post-cardiopulmonary bypass-associated acute kidney injury: a single-center retrospective analysis. J Cardiothorac Vasc Anesth. 2014;28(3):551–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Suneja M, Kumar AB. Obesity and perioperative acute kidney injury: a focused review. J Crit Care. 2014;29(4):694.e1–6.CrossRefGoogle Scholar
  16. 16.
    Wiedermann CJ. Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis. BMC Emerg Med. 2008;8:1.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367(20):1901–11.CrossRefGoogle Scholar
  18. 18.
    Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012;367(2):124–34.CrossRefGoogle Scholar
  19. 19.
    Haase N, Perner A, Hennings LI, et al. Hydroxyethyl starch 130/0.38–0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis. BMJ. 2013;346:f839.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Zarychanski R, Abou-Setta AM, Turgeon AF, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA. 2013;309(7):678–88.CrossRefPubMedGoogle Scholar
  21. 21.
    Cardinal-Fernandez P, Ferruelo A, Martin-Pellicer A, et al. Genetic determinants of acute renal damage risk and prognosis: a systematic review. Med Intensiva. 2012;36(9):626–33.CrossRefPubMedGoogle Scholar
  22. 22.
    Zhao B, Lu Q, Cheng Y, et al. A genome-wide association study to identify single-nucleotide polymorphisms for acute kidney injury. Am J Respir Crit Care Med. 2017;195(4):482–90.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20(1):223–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Wald R, Quinn RR, Luo J, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA. 2009;302:1179–85.CrossRefPubMedGoogle Scholar
  25. 25.
    Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int. 2011;79:1361–9.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81:442–8.CrossRefGoogle Scholar
  27. 27.
    Bucaloiu ID, Kirchner HL, Norfolk ER, Hartle JE, Perkins RM. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012;81:477–85.CrossRefPubMedGoogle Scholar
  28. 28.
    Heung M, Steffick DE, Zivin K, et al. Acute kidney injury recovery pattern and subsequent risk of CKD: an analysis of Veterans Health Administration Data. Am J Kidney Dis. 2016;67(5):742–52.CrossRefGoogle Scholar
  29. 29.
    Lewington AJ, Cerda J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013;84(3):457–67.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014;371(1):58–66.CrossRefGoogle Scholar
  31. 31.
    VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20.CrossRefGoogle Scholar
  32. 32.
    Wu VC, Wu CH, Huang TM, et al. Long-term risk of coronary events after AKI. J Am Soc Nephrol. 2014;25(3):595–605.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Wu VC, Wu PC, Wu CH, et al. The impact of acute kidney injury on the long-term risk of stroke. J Am Heart Assoc. 2014;3(4):e000933.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Wang WJ, Chao CT, Huang YC, et al. The impact of acute kidney injury with temporary dialysis on the risk of fracture. J Bone Miner Res. 2014;29(3):676–84.CrossRefPubMedGoogle Scholar
  35. 35.
    Lai TS, Wang CY, Pan SC, et al. Risk of developing severe sepsis after acute kidney injury: a population-based cohort study. Crit Care. 2013;17(5):R231.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Wu PC, Wu CJ, Lin CJ, et al. Long-term risk of upper gastrointestinal hemorrhage after advanced AKI. Clin J Am Soc Nephrol. 2015;10(3):353–62.CrossRefPubMedGoogle Scholar
  37. 37.
    Villeneuve PM, Clark EG, Sikora L, Sood MM, Bagshaw SM. Health-related quality-of-life among survivors of acute kidney injury in the intensive care unit: a systematic review. Intensive Care Med. 2016;42(2):137–46.CrossRefPubMedGoogle Scholar
  38. 38.
    Gallagher M, Cass A, Bellomo R, et al. Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med. 2014;11(2):e1001601.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Linder A, Fjell C, Levin A, Walley KR, Russell JA, Boyd JH. Small acute increases in serum creatinine are associated with decreased long-term survival in the critically ill. Am J Respir Crit Care Med. 2014;189(9):1075–81.CrossRefGoogle Scholar
  40. 40.
    Harel Z, Bell CM, Dixon SN, et al. Predictors of progression to chronic dialysis in survivors of severe acute kidney injury: a competing risk study. BMC Nephrol. 2014;15:114.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Ishani A, Nelson D, Clothier B, et al. The magnitude of acute serum creatinine increase after cardiac surgery and the risk of chronic kidney disease, progression of kidney disease and death. Arch Intern Med. 2011;171:226–33.CrossRefGoogle Scholar
  42. 42.
    Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int. 2012;82:516–24.CrossRefPubMedGoogle Scholar
  43. 43.
    Thakar CV, Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 2011;6:2567–72.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Ferenbach DA, Bonventre JV. Acute kidney injury and chronic kidney disease: from the laboratory to the clinic. Nephrol Ther. 2016;12(12 Suppl):S41–8.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Ferenbach DA, Bonventre JV. Mechanisms of maladaptive repair after AKI leading to accelerated kidney ageing and CKD. Nat Rev Nephrol. 2015;11(5):264–76.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Varrier M, Forni LG, Ostermann M. Long-term sequelae from acute kidney injury: potential mechanisms for the observed poor renal outcomes. Crit Care. 2015;19(1):R102.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Nephrology and Critical Care MedicineKing’s College London, Guy’s & St Thomas’ Foundation HospitalLondonUK

Personalised recommendations