Acute Kidney Injury Duration and 20-Year Risks of CKD and Cardiovascular Disease

Overview

Journal Kidney Int Rep

Publisher Elsevier

Specialty Nephrology

Date 2024 May 20

PMID 38765592

Authors

Simon K Jensen

Uffe Heide-Jorgensen

Henrik Gammelager

Henrik Birn

Christian F Christiansen

Affiliations

Soon will be listed here.

Abstract

Introduction: Acute kidney injury (AKI) is associated with chronic kidney disease (CKD) and cardiovascular disease (CVD); however, it is unclear whether AKI duration affects the long-term risks of CKD and CVD. Therefore, we performed a population-based cohort study examining the associations between AKI duration and CKD and CVD.

Methods: We identified patients with laboratory-recorded AKI in Denmark from 1990 through 2018. AKIs were categorized as rapid reversal AKI (≤48 hours), persistent AKI (2-7 days), and acute kidney disease (AKD) (>7 days). We estimated 20-year risks and adjusted hazard ratios (aHRs) of incident CKD and CVD.

Results: The study comprised 169,582 patients with AKI, with 100,478 and 76,838 included in the analysis of CKD and CVD, respectively. The 20-year risks of CKD were 26.3%, 29.5%, and 28.7% for rapid reversal AKI, persistent AKI, and AKD, respectively. Compared with rapid reversal AKI, aHRs were 1.13 (95% confidence interval [CI], 1.08-1.19) for persistent AKI and 1.36 (95% CI, 1.30-1.41) for AKD. Risks and rates of overall CVD were similar for rapid reversal AKI, persistent AKI, and AKD. However, persistent AKI was associated with a slightly increased aHR of heart failure (1.09; 95% CI, 1.02-1.16), and aHRs of heart failure, ischemic heart disease, and peripheral artery disease were slightly increased for AKD (1.09 [95% CI, 1.03-1.15], 1.11 [95% CI, 1.03-1.19], and 1.10 [95% CI, 1.02-1.17], respectively).

Conclusion: AKI duration was associated with development of CKD, but not overall CVD; however, rates of heart failure, ischemic heart disease, and peripheral artery disease increased slightly with AKI duration.

References

James M, Ghali W, Knudtson M, Ravani P, Tonelli M, Faris P . Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography. Circulation. 2011; 123(4):409-16. DOI: 10.1161/CIRCULATIONAHA.110.970160. View

Pannu N, James M, Hemmelgarn B, Klarenbach S . Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol. 2012; 8(2):194-202. PMC: 3562863. DOI: 10.2215/CJN.06480612. View

Bhatraju P, Zelnick L, Chinchilli V, Moledina D, Coca S, Parikh C . Association Between Early Recovery of Kidney Function After Acute Kidney Injury and Long-term Clinical Outcomes. JAMA Netw Open. 2020; 3(4):e202682. PMC: 7154800. DOI: 10.1001/jamanetworkopen.2020.2682. View

Haines R, Powell-Tuck J, Leonard H, Crichton S, Ostermann M . Long-term kidney function of patients discharged from hospital after an intensive care admission: observational cohort study. Sci Rep. 2021; 11(1):9928. PMC: 8113423. DOI: 10.1038/s41598-021-89454-3. View

Pottegard A, Schmidt S, Wallach-Kildemoes H, Sorensen H, Hallas J, Schmidt M . Data Resource Profile: The Danish National Prescription Registry. Int J Epidemiol. 2016; 46(3):798-798f. PMC: 5837522. DOI: 10.1093/ije/dyw213. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596):1453-7. DOI: 10.1016/S0140-6736(07)61602-X. View

Heung M, Steffick D, Zivin K, Gillespie B, Banerjee T, Hsu C . Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data. Am J Kidney Dis. 2015; 67(5):742-52. PMC: 6837804. DOI: 10.1053/j.ajkd.2015.10.019. View

Wu V, Wu C, Huang T, Wang C, Lai C, Shiao C . Long-term risk of coronary events after AKI. J Am Soc Nephrol. 2014; 25(3):595-605. PMC: 3935592. DOI: 10.1681/ASN.2013060610. View

Mehta S, Chauhan K, Patel A, Patel S, Pinotti R, Nadkarni G . The prognostic importance of duration of AKI: a systematic review and meta-analysis. BMC Nephrol. 2018; 19(1):91. PMC: 5907696. DOI: 10.1186/s12882-018-0876-7. View

10.

Jensen S, Heide-Jorgensen U, Vestergaard S, Sorensen H, Christiansen C . Routine Clinical Care Creatinine Data in Denmark - An Epidemiological Resource for Nationwide Population-Based Studies of Kidney Disease. Clin Epidemiol. 2022; 14:1415-1426. PMC: 9700471. DOI: 10.2147/CLEP.S380840. View

11.

Choi A, Li Y, Parikh C, Volberding P, Shlipak M . Long-term clinical consequences of acute kidney injury in the HIV-infected. Kidney Int. 2010; 78(5):478-85. PMC: 3913062. DOI: 10.1038/ki.2010.171. View

12.

Chawla L, Bellomo R, Bihorac A, Goldstein S, Siew E, Bagshaw S . Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017; 13(4):241-257. DOI: 10.1038/nrneph.2017.2. View

13.

Coca S, King Jr J, Rosenthal R, Perkal M, Parikh C . The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans. Kidney Int. 2010; 78(9):926-33. PMC: 3082138. DOI: 10.1038/ki.2010.259. View

14.

Hsu C, Hsu R, Yang J, Ordonez J, Zheng S, Go A . Elevated BP after AKI. J Am Soc Nephrol. 2015; 27(3):914-23. PMC: 4769190. DOI: 10.1681/ASN.2014111114. View

15.

Siew E, Abdel-Kader K, Perkins A, Greevy Jr R, Parr S, Horner J . Timing of Recovery From Moderate to Severe AKI and the Risk for Future Loss of Kidney Function. Am J Kidney Dis. 2019; 75(2):204-213. DOI: 10.1053/j.ajkd.2019.05.031. View

16.

Goldberg A, Kogan E, Hammerman H, Markiewicz W, Aronson D . The impact of transient and persistent acute kidney injury on long-term outcomes after acute myocardial infarction. Kidney Int. 2009; 76(8):900-6. DOI: 10.1038/ki.2009.295. View

17.

Wu V, Huang T, Lai C, Shiao C, Lin Y, Chu T . Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Kidney Int. 2011; 80(11):1222-30. DOI: 10.1038/ki.2011.259. View

18.

Prowle J, Forni L, Bell M, Chew M, Edwards M, Grams M . Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative. Nat Rev Nephrol. 2021; 17(9):605-618. PMC: 8367817. DOI: 10.1038/s41581-021-00418-2. View

19.

Sawhney S, Mitchell M, Marks A, Fluck N, Black C . Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review. BMJ Open. 2015; 5(1):e006497. PMC: 4289733. DOI: 10.1136/bmjopen-2014-006497. View

20.

Patel S, Palant C, Mahajan V, Chawla L . Sequelae of AKI. Best Pract Res Clin Anaesthesiol. 2017; 31(3):415-425. DOI: 10.1016/j.bpa.2017.08.004. View