Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2009 Jun;53(6):961-73.
doi: 10.1053/j.ajkd.2008.11.034. Epub 2009 Apr 5.

Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis

Steven G Coca  1 , Bushra Yusuf, Michael G Shlipak, Amit X Garg, Chirag R Parikh
Affiliations
Meta-Analysis

Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis

Steven G Coca et al. Am J Kidney Dis. 2009 Jun.

Abstract

Background: Acute kidney injury (AKI) is common in hospitalized patients. The impact of AKI on long-term outcomes is controversial.

Study design: Systematic review and meta-analysis.

Setting & participants: Persons with AKI.

Selection criteria for studies: MEDLINE and EMBASE databases were searched from 1985 through October 2007. Original studies describing outcomes of AKI for patients who survived hospital discharge were included. Studies were excluded from review when participants were followed up for less than 6 months.

Predictor: AKI, defined as acute changes in serum creatinine level or acute need for renal replacement therapy.

Outcomes: Chronic kidney disease (CKD), cardiovascular disease, and mortality.

Results: 48 studies that contained a total of 47,017 participants were reviewed; 15 studies reported long-term data for patients without AKI. The incidence rate of mortality was 8.9 deaths/100 person-years in survivors of AKI and 4.3 deaths/100 patient-years in survivors without AKI (rate ratio [RR], 2.59; 95% confidence interval, 1.97 to 3.42). AKI was associated independently with mortality risk in 6 of 6 studies that performed multivariate adjustment (adjusted RR, 1.6 to 3.9) and with myocardial infarction in 2 of 2 studies (RR, 2.05; 95% confidence interval, 1.61 to 2.61). The incidence rate of CKD after an episode of AKI was 7.8 events/100 patient-years, and the rate of end-stage renal disease was 4.9 events/100 patient-years.

Limitations: The relative risk for CKD and end-stage renal disease after AKI was unattainable because of lack of follow-up of appropriate controls without AKI.

Conclusions: The development of AKI, defined as acute changes in serum creatinine level, characterizes hospitalized patients at increased risk of long-term adverse outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flow diagram of studies with long term outcomes of AKI that were considered for inclusion
Figure 2
Figure 2. Pooled rate ratio of long-term mortality for survivors of AKI
Overall RR 2.62 (95% CI 1.99-3.45); I2 = 86% Abbreviations: Txp, transplantation; RRT, renal replacement therapy; PCI, Percutaneous intervention; LVAD, left ventricular assist device AKI, acute kidney injury.
Figure 3
Figure 3. Pooled rate ratios for long-term death by severity of AKI
A. Mild AKI (Rise in creatinine by 25% or drop in creatinine clearance of > 10%) RR 1.67 (95% CI 1.41-1.98); I2 = 0% B. Moderate AKI (Rise in creatinine by > 50%, > 100%, > 1.0 mg/dl, or creatinine concentration of > 1.7 mg/dL) RR 2.70 (95% CI 1.77-4.12), I2 = 89% C. Severe AKI (RRT-requiring) RR 3.09 (95% CI 2.20-4.33), I2 = 66%
See this image and copyright information in PMC

Comment in

References

    1. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005 Nov;16(11):3365–3370. - PubMed
    1. Hsu CY, McCulloch CE, Fan D, Ordonez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int. 2007 Jul;72(2):208–212. - PMC - PubMed
    1. Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol. 2006 Apr;17(4):1143–1150. - PubMed
    1. de Mendonca A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000 Jul;26(7):915–921. - PubMed
    1. Forman DE, Butler J, Wang Y, et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol. 2004 Jan 7;43(1):61–67. - PubMed

Publication types