TY - JOUR
T1 - A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death
AU - ASSESS-AKI Study Investigators
AU - Ikizler, T. Alp
AU - Parikh, Chirag R.
AU - Himmelfarb, Jonathan
AU - Chinchilli, Vernon M.
AU - Liu, Kathleen D.
AU - Coca, Steven G.
AU - Garg, Amit X.
AU - Hsu, Chi yuan
AU - Siew, Edward D.
AU - Wurfel, Mark M.
AU - Ware, Lorraine B.
AU - Faulkner, Georgia Brown
AU - Tan, Thida C.
AU - Kaufman, James S.
AU - Kimmel, Paul L.
AU - Go, Alan S.
AU - Stokes, John B.
AU - Coca, Steven
AU - Zheng, Sijie
AU - Pravoverov, Leonid
AU - Hsu, Raymond K.
AU - Reeves, W. Brian
AU - Lewis, Julia B.
AU - Ware, Lorraine
AU - Devarajan, Prasad
AU - Krawczeski, Catherine
AU - Bennett, Michael
AU - Zappitelli, Michael
AU - Wurfel, Mark
N1 - Publisher Copyright:
© 2020 International Society of Nephrology
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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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U2 - 10.1016/j.kint.2020.06.032
DO - 10.1016/j.kint.2020.06.032
M3 - Article
C2 - 32707221
AN - SCOPUS:85091406371
SN - 0085-2538
VL - 99
SP - 456
EP - 465
JO - Kidney International
JF - Kidney International
IS - 2
ER -