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Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study

BACKGROUND: Observational studies relying on clinically obtained data have shown that acute kidney injury (AKI) is linked to accelerated chronic kidney disease (CKD) progression. However, prior reports lacked uniform collection of important confounders such as proteinuria and pre-AKI kidney function...

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Autores principales: Hsu, Raymond K, Hsu, Chi-yuan, McCulloch, Charles E, Yang, Jingrong, Anderson, Amanda H, Chen, Jing, Feldman, Harold I, He, Jiang, Liu, Kathleen D, Navaneethan, Sankar D, Porter, Anna C, Rahman, Mahboob, Tan, Thida C, Wilson, F Perry, Xie, Dawei, Zhang, Xiaoming, Go, Alan S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
AKI
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025351/
https://www.ncbi.nlm.nih.gov/pubmed/32082553
http://dx.doi.org/10.1093/ckj/sfz057
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author Hsu, Raymond K
Hsu, Chi-yuan
McCulloch, Charles E
Yang, Jingrong
Anderson, Amanda H
Chen, Jing
Feldman, Harold I
He, Jiang
Liu, Kathleen D
Navaneethan, Sankar D
Porter, Anna C
Rahman, Mahboob
Tan, Thida C
Wilson, F Perry
Xie, Dawei
Zhang, Xiaoming
Go, Alan S
author_facet Hsu, Raymond K
Hsu, Chi-yuan
McCulloch, Charles E
Yang, Jingrong
Anderson, Amanda H
Chen, Jing
Feldman, Harold I
He, Jiang
Liu, Kathleen D
Navaneethan, Sankar D
Porter, Anna C
Rahman, Mahboob
Tan, Thida C
Wilson, F Perry
Xie, Dawei
Zhang, Xiaoming
Go, Alan S
author_sort Hsu, Raymond K
collection PubMed
description BACKGROUND: Observational studies relying on clinically obtained data have shown that acute kidney injury (AKI) is linked to accelerated chronic kidney disease (CKD) progression. However, prior reports lacked uniform collection of important confounders such as proteinuria and pre-AKI kidney function trajectory, and may be susceptible to ascertainment bias, as patients may be more likely to undergo kidney function testing after AKI. METHODS: We studied 444 adults with CKD who participated in the prospective Chronic Renal Insufficiency Cohort (CRIC) Study and were concurrent members of a large integrated healthcare delivery system. We estimated glomerular filtration rate (eGFR) trajectories using serum creatinine measurements from (i) the CRIC research protocol (yearly) and (ii) routine clinical care. We used linear mixed effects models to evaluate the associations of AKI with acute absolute change in eGFR and post-AKI eGFR slope, and explored whether these varied by source of creatinine results. Models were adjusted for demographic characteristics, diabetes status and albuminuria. RESULTS: During median follow-up of 8.5 years, mean rate of eGFR loss was −0.31 mL/min/1.73 m(2)/year overall, and 73 individuals experienced AKI (55% Stage 1). A significant interaction existed between AKI and source of serum creatinine for acute absolute change in eGFR level after discharge; in contrast, AKI was independently associated with a faster rate of eGFR decline (mean additional loss of −0.67 mL/min/1.73 m(2)/year), which was not impacted by source of serum creatinine. CONCLUSIONS: AKI is independently associated with subsequent steeper eGFR decline regardless of the serum creatinine source used, but the strength of association is smaller than observed in prior studies after taking into account key confounders such as pre-AKI eGFR slope and albuminuria.
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spelling pubmed-70253512020-02-20 Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study Hsu, Raymond K Hsu, Chi-yuan McCulloch, Charles E Yang, Jingrong Anderson, Amanda H Chen, Jing Feldman, Harold I He, Jiang Liu, Kathleen D Navaneethan, Sankar D Porter, Anna C Rahman, Mahboob Tan, Thida C Wilson, F Perry Xie, Dawei Zhang, Xiaoming Go, Alan S Clin Kidney J AKI BACKGROUND: Observational studies relying on clinically obtained data have shown that acute kidney injury (AKI) is linked to accelerated chronic kidney disease (CKD) progression. However, prior reports lacked uniform collection of important confounders such as proteinuria and pre-AKI kidney function trajectory, and may be susceptible to ascertainment bias, as patients may be more likely to undergo kidney function testing after AKI. METHODS: We studied 444 adults with CKD who participated in the prospective Chronic Renal Insufficiency Cohort (CRIC) Study and were concurrent members of a large integrated healthcare delivery system. We estimated glomerular filtration rate (eGFR) trajectories using serum creatinine measurements from (i) the CRIC research protocol (yearly) and (ii) routine clinical care. We used linear mixed effects models to evaluate the associations of AKI with acute absolute change in eGFR and post-AKI eGFR slope, and explored whether these varied by source of creatinine results. Models were adjusted for demographic characteristics, diabetes status and albuminuria. RESULTS: During median follow-up of 8.5 years, mean rate of eGFR loss was −0.31 mL/min/1.73 m(2)/year overall, and 73 individuals experienced AKI (55% Stage 1). A significant interaction existed between AKI and source of serum creatinine for acute absolute change in eGFR level after discharge; in contrast, AKI was independently associated with a faster rate of eGFR decline (mean additional loss of −0.67 mL/min/1.73 m(2)/year), which was not impacted by source of serum creatinine. CONCLUSIONS: AKI is independently associated with subsequent steeper eGFR decline regardless of the serum creatinine source used, but the strength of association is smaller than observed in prior studies after taking into account key confounders such as pre-AKI eGFR slope and albuminuria. Oxford University Press 2019-05-20 /pmc/articles/PMC7025351/ /pubmed/32082553 http://dx.doi.org/10.1093/ckj/sfz057 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle AKI
Hsu, Raymond K
Hsu, Chi-yuan
McCulloch, Charles E
Yang, Jingrong
Anderson, Amanda H
Chen, Jing
Feldman, Harold I
He, Jiang
Liu, Kathleen D
Navaneethan, Sankar D
Porter, Anna C
Rahman, Mahboob
Tan, Thida C
Wilson, F Perry
Xie, Dawei
Zhang, Xiaoming
Go, Alan S
Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study
title Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study
title_full Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study
title_fullStr Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study
title_full_unstemmed Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study
title_short Research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the Chronic Renal Insufficiency Cohort study
title_sort research-based versus clinical serum creatinine measurements and the association of acute kidney injury with subsequent kidney function: findings from the chronic renal insufficiency cohort study
topic AKI
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025351/
https://www.ncbi.nlm.nih.gov/pubmed/32082553
http://dx.doi.org/10.1093/ckj/sfz057
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