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A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death

Acute kidney injury (AKI) has been reported to be associated with excess risks of death, kidney disease progression and cardiovascular events although previous studies have important limitations. To further examine this, we prospectively studied adults from four clinical centers surviving three mont...

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Autores principales: Ikizler, T. Alp, Parikh, Chirag R., Himmelfarb, Jonathan, Chinchilli, Vernon M., Liu, Kathleen D., Coca, Steven G., Garg, Amit X., Hsu, Chi-yuan, Siew, Edward D., Wurfel, Mark M., Ware, Lorraine B., Faulkner, Georgia Brown, Tan, Thida C., Kaufman, James S., Kimmel, Paul L., Go, Alan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Society of Nephrology. Published by Elsevier Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374148/
https://www.ncbi.nlm.nih.gov/pubmed/32707221
http://dx.doi.org/10.1016/j.kint.2020.06.032
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author Ikizler, T. Alp
Parikh, Chirag R.
Himmelfarb, Jonathan
Chinchilli, Vernon M.
Liu, Kathleen D.
Coca, Steven G.
Garg, Amit X.
Hsu, Chi-yuan
Siew, Edward D.
Wurfel, Mark M.
Ware, Lorraine B.
Faulkner, Georgia Brown
Tan, Thida C.
Kaufman, James S.
Kimmel, Paul L.
Go, Alan S.
author_facet Ikizler, T. Alp
Parikh, Chirag R.
Himmelfarb, Jonathan
Chinchilli, Vernon M.
Liu, Kathleen D.
Coca, Steven G.
Garg, Amit X.
Hsu, Chi-yuan
Siew, Edward D.
Wurfel, Mark M.
Ware, Lorraine B.
Faulkner, Georgia Brown
Tan, Thida C.
Kaufman, James S.
Kimmel, Paul L.
Go, Alan S.
author_sort Ikizler, T. Alp
collection PubMed
description Acute kidney injury (AKI) has been reported to be associated with excess risks of death, kidney disease progression and cardiovascular events although previous studies have important limitations. To further examine this, we prospectively studied adults from four clinical centers surviving three months and more after hospitalization with or without AKI who were matched on center, pre-admission CKD status, and an integrated priority score based on age, prior cardiovascular disease or diabetes mellitus, preadmission estimated glomerular filtration rate (eGFR) and treatment in the intensive care unit during the index hospitalization between December 2009-February 2015, with follow-up through November 2018. All participants had assessments of kidney function before (eGFR) and at three months and annually (eGFR and proteinuria) after the index hospitalization. Associations of AKI with outcomes were examined after accounting for pre-admission and three-month post-discharge factors. Among 769 AKI (73% Stage 1, 14% Stage 2, 13% Stage 3) and 769 matched non-AKI adults, AKI was associated with higher adjusted rates of incident CKD (adjusted hazard ratio 3.98, 95% confidence interval 2.51-6.31), CKD progression (2.37,1.28-4.39), heart failure events (1.68, 1.22-2.31) and all-cause death (1.78, 1.24-2.56). AKI was not associated with major atherosclerotic cardiovascular events in multivariable analysis (0.95, 0.70-1.28). After accounting for degree of kidney function recovery and proteinuria at three months after discharge, the associations of AKI with heart failure (1.13, 0.80-1.61) and death (1.29, 0.84-1.98) were attenuated and no longer significant. Thus, assessing kidney function recovery and proteinuria status three months after AKI provides important prognostic information for long-term clinical outcomes.
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spelling pubmed-73741482020-07-22 A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death Ikizler, T. Alp Parikh, Chirag R. Himmelfarb, Jonathan Chinchilli, Vernon M. Liu, Kathleen D. Coca, Steven G. Garg, Amit X. Hsu, Chi-yuan Siew, Edward D. Wurfel, Mark M. Ware, Lorraine B. Faulkner, Georgia Brown Tan, Thida C. Kaufman, James S. Kimmel, Paul L. Go, Alan S. Kidney Int Clinical Investigation Acute kidney injury (AKI) has been reported to be associated with excess risks of death, kidney disease progression and cardiovascular events although previous studies have important limitations. To further examine this, we prospectively studied adults from four clinical centers surviving three months and more after hospitalization with or without AKI who were matched on center, pre-admission CKD status, and an integrated priority score based on age, prior cardiovascular disease or diabetes mellitus, preadmission estimated glomerular filtration rate (eGFR) and treatment in the intensive care unit during the index hospitalization between December 2009-February 2015, with follow-up through November 2018. All participants had assessments of kidney function before (eGFR) and at three months and annually (eGFR and proteinuria) after the index hospitalization. Associations of AKI with outcomes were examined after accounting for pre-admission and three-month post-discharge factors. Among 769 AKI (73% Stage 1, 14% Stage 2, 13% Stage 3) and 769 matched non-AKI adults, AKI was associated with higher adjusted rates of incident CKD (adjusted hazard ratio 3.98, 95% confidence interval 2.51-6.31), CKD progression (2.37,1.28-4.39), heart failure events (1.68, 1.22-2.31) and all-cause death (1.78, 1.24-2.56). AKI was not associated with major atherosclerotic cardiovascular events in multivariable analysis (0.95, 0.70-1.28). After accounting for degree of kidney function recovery and proteinuria at three months after discharge, the associations of AKI with heart failure (1.13, 0.80-1.61) and death (1.29, 0.84-1.98) were attenuated and no longer significant. Thus, assessing kidney function recovery and proteinuria status three months after AKI provides important prognostic information for long-term clinical outcomes. International Society of Nephrology. Published by Elsevier Inc. 2021-02 2020-07-22 /pmc/articles/PMC7374148/ /pubmed/32707221 http://dx.doi.org/10.1016/j.kint.2020.06.032 Text en © 2020 International Society of Nephrology. Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Clinical Investigation
Ikizler, T. Alp
Parikh, Chirag R.
Himmelfarb, Jonathan
Chinchilli, Vernon M.
Liu, Kathleen D.
Coca, Steven G.
Garg, Amit X.
Hsu, Chi-yuan
Siew, Edward D.
Wurfel, Mark M.
Ware, Lorraine B.
Faulkner, Georgia Brown
Tan, Thida C.
Kaufman, James S.
Kimmel, Paul L.
Go, Alan S.
A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
title A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
title_full A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
title_fullStr A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
title_full_unstemmed A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
title_short A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
title_sort prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
topic Clinical Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374148/
https://www.ncbi.nlm.nih.gov/pubmed/32707221
http://dx.doi.org/10.1016/j.kint.2020.06.032
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