Abstract
Background
The incidence of acute kidney injury (AKI) is increasing. AKI is currently recognised as an inducer of chronic kidney disease (CKD) and this is known as the ‘AKI–CKD transition’. This study aimed to evaluate the rate of decline in estimated glomerular filtration rate (eGFR) associated with AKI events in individuals with and without pre-existing CKD.
Methods
Inpatients aged 18–80 years were retrospectively enrolled. AKI was diagnosed according to the kidney disease improving global outcomes (KDIGO) criteria using serum creatinine levels. Patients with a history of AKI events were divided into four groups according to eGFR before and after the AKI events. In each group, the eGFR levels after an AKI event were compared to those before the AKI event. Patients were further divided into eight groups according to clinical background based on underlying diseases, medications, and surgical history.
Results
We analysed data from 9651 patients with AKI. Not surprisingly, we found that eGFR levels during the first AKI event were significantly lower than levels before the event in each group. Furthermore, eGFR levels after the first AKI event were significantly lower than those before the first AKI event, and the eGFR levels after the second AKI event were significantly lower than those after the first AKI event. These trends were similar in each group irrespective of clinical background.
Conclusions
Our study revealed that AKI events can cause a decline in kidney function and, as more AKI events occur, acceleration of this decline.
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References
American Society of Nephrology. American society of nephrology renal research report. J Am Soc Nephrol. 2005;16:1886–903.
Venkatachalam MA, Weinberg JM, Kriz W, Bidani AK. Failed tubule recovery, AKI–CKD transition, and kidney disease progression. J Am Soc Nephrol. 2015;26:1765–76.
Otomo K, Horino T, Miki T, Kataoka H, Hatakeyama Y, Matsumoto T, et al. Serum uric acid level as a risk factor for acute kidney injury in hospitalized patients: a retrospective database analysis using the integrated medical information system at Kochi Medical School hospital. Clin Exp Nephrol. 2016;20:235–43.
Kidney Disease: Improving global outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2:1–138.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.
Kjellstrand CM, Ebben J, Davin T. Time of death, recovery of renal function, development of chronic renal failure and need for chronic hemodialysis in patients with acute tubular necrosis. Trans Am Soc Artif Intern Organs. 1981;27:45–50.
Liaño F, Felipe C, Tenorio MT, Rivera M, Abraira V, Sáez-de-Urturi JM, et al. Long-term outcome of acute tubular necrosis: a contribution to its natural history. Kidney Int. 2007;71:679–86.
Lowe KG. The late prognosis in acute tubular necrosis; an interim follow-up report on 14 patients. Lancet. 1952;1:1086–8.
Finkenstaedt JT, Merrill JP. Renal function after recovery from acute renal failure. N Engl J Med. 1956;254:1023–6.
Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int. 2012;82:516–24.
Hostetter TH. Progression of renal disease and renal hypertrophy. Annu Rev Physiol. 1995;57:263–78.
Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. J Am Soc Nephrol. 2001;12:1315–25.
Baldwin DS, Neugarten J. Hypertension and renal diseases. Am J Kidney Dis. 1987;10:186 – 91.
Acknowledgements
This work was supported by The Kidney Foundation Japan and Kochi Organization for Medical Reformation and Renewal (to YT) and by a Grant from the Ministry of Education, Science, Culture, and Sports of Japan (to YT and YO).
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The authors have declared that no conflict of interest exists.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 23-15) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Hatakeyama, Y., Horino, T., Nagata, K. et al. Transition from acute kidney injury to chronic kidney disease: a single-centre cohort study. Clin Exp Nephrol 22, 1281–1293 (2018). https://doi.org/10.1007/s10157-018-1571-5
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DOI: https://doi.org/10.1007/s10157-018-1571-5