Cargando…

Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study

BACKGROUND: The high mortality and cardiovascular disease (CVD) burden in patients with end-stage renal disease (ESRD) is well-documented. Recent literature suggests that acute kidney injury is also associated with CVD. It is unknown whether patients with incident ESRD due to dialysis-requiring acut...

Descripción completa

Detalles Bibliográficos
Autores principales: Lee, Benjamin J., Hsu, Chi-yuan, Parikh, Rishi V., Leong, Thomas K., Tan, Thida C., Walia, Sophia, Liu, Kathleen D., Hsu, Raymond K., Go, Alan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996504/
https://www.ncbi.nlm.nih.gov/pubmed/29890946
http://dx.doi.org/10.1186/s12882-018-0924-3
_version_ 1783330875055800320
author Lee, Benjamin J.
Hsu, Chi-yuan
Parikh, Rishi V.
Leong, Thomas K.
Tan, Thida C.
Walia, Sophia
Liu, Kathleen D.
Hsu, Raymond K.
Go, Alan S.
author_facet Lee, Benjamin J.
Hsu, Chi-yuan
Parikh, Rishi V.
Leong, Thomas K.
Tan, Thida C.
Walia, Sophia
Liu, Kathleen D.
Hsu, Raymond K.
Go, Alan S.
author_sort Lee, Benjamin J.
collection PubMed
description BACKGROUND: The high mortality and cardiovascular disease (CVD) burden in patients with end-stage renal disease (ESRD) is well-documented. Recent literature suggests that acute kidney injury is also associated with CVD. It is unknown whether patients with incident ESRD due to dialysis-requiring acute kidney injury (AKI-D) are at higher short-term risk for death and CVD events, compared with incident ESRD patients without preceding AKI-D. Few studies have examined the impact of recovery from AKI-D on subsequent CVD risk. METHODS: In this retrospective cohort study, we evaluated adult members of Kaiser Permanente Northern California who initiated dialysis from January 2009 to September 2015. Preceding AKI-D and subsequent outcomes of death and CVD events (acute coronary syndrome, heart failure, ischemic stroke or transient ischemic attack) were identified from electronic health records. We performed multivariable Cox regression models adjusting for demographics, comorbidities, medication use, and laboratory results. RESULTS: Compared to incident ESRD patients who experienced AKI-D (n = 1865), patients with ESRD not due to AKI-D (n = 3772) had significantly lower adjusted rates of death (adjusted hazard ratio [aHR] 0.56, 95% CI: 0.47–0.67) and heart failure hospitalization (aHR 0.45, 0.30–0.70). Compared to AKI-D patients who did not recover and progressed to ESRD, AKI-D patients who recovered (n = 1347) had a 30% lower adjusted relative rate of death (aHR 0.70, 0.55–0.88). CONCLUSIONS: Patients who transition to ESRD via AKI-D are a high-risk subgroup that may benefit from aggressive monitoring and medical management, particularly for heart failure. Recovery from AKI-D is independently associated with lower short-term mortality.
format Online
Article
Text
id pubmed-5996504
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-59965042018-06-25 Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study Lee, Benjamin J. Hsu, Chi-yuan Parikh, Rishi V. Leong, Thomas K. Tan, Thida C. Walia, Sophia Liu, Kathleen D. Hsu, Raymond K. Go, Alan S. BMC Nephrol Research Article BACKGROUND: The high mortality and cardiovascular disease (CVD) burden in patients with end-stage renal disease (ESRD) is well-documented. Recent literature suggests that acute kidney injury is also associated with CVD. It is unknown whether patients with incident ESRD due to dialysis-requiring acute kidney injury (AKI-D) are at higher short-term risk for death and CVD events, compared with incident ESRD patients without preceding AKI-D. Few studies have examined the impact of recovery from AKI-D on subsequent CVD risk. METHODS: In this retrospective cohort study, we evaluated adult members of Kaiser Permanente Northern California who initiated dialysis from January 2009 to September 2015. Preceding AKI-D and subsequent outcomes of death and CVD events (acute coronary syndrome, heart failure, ischemic stroke or transient ischemic attack) were identified from electronic health records. We performed multivariable Cox regression models adjusting for demographics, comorbidities, medication use, and laboratory results. RESULTS: Compared to incident ESRD patients who experienced AKI-D (n = 1865), patients with ESRD not due to AKI-D (n = 3772) had significantly lower adjusted rates of death (adjusted hazard ratio [aHR] 0.56, 95% CI: 0.47–0.67) and heart failure hospitalization (aHR 0.45, 0.30–0.70). Compared to AKI-D patients who did not recover and progressed to ESRD, AKI-D patients who recovered (n = 1347) had a 30% lower adjusted relative rate of death (aHR 0.70, 0.55–0.88). CONCLUSIONS: Patients who transition to ESRD via AKI-D are a high-risk subgroup that may benefit from aggressive monitoring and medical management, particularly for heart failure. Recovery from AKI-D is independently associated with lower short-term mortality. BioMed Central 2018-06-11 /pmc/articles/PMC5996504/ /pubmed/29890946 http://dx.doi.org/10.1186/s12882-018-0924-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Lee, Benjamin J.
Hsu, Chi-yuan
Parikh, Rishi V.
Leong, Thomas K.
Tan, Thida C.
Walia, Sophia
Liu, Kathleen D.
Hsu, Raymond K.
Go, Alan S.
Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
title Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
title_full Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
title_fullStr Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
title_full_unstemmed Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
title_short Non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
title_sort non-recovery from dialysis-requiring acute kidney injury and short-term mortality and cardiovascular risk: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996504/
https://www.ncbi.nlm.nih.gov/pubmed/29890946
http://dx.doi.org/10.1186/s12882-018-0924-3
work_keys_str_mv AT leebenjaminj nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT hsuchiyuan nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT parikhrishiv nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT leongthomask nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT tanthidac nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT waliasophia nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT liukathleend nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT hsuraymondk nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy
AT goalans nonrecoveryfromdialysisrequiringacutekidneyinjuryandshorttermmortalityandcardiovascularriskacohortstudy