Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease

Abstract

To determine whether acute renal failure (ARF) increases the long-term risk of progressive chronic kidney disease (CKD), we studied the outcome of patients whose initial kidney function was normal or near normal but who had an episode of dialysis-requiring ARF and did not develop end-stage renal disease within 30 days following hospital discharge. The study encompassed 556,090 adult members of Kaiser Permanente of Northern California hospitalized over an 8 year period, who had pre-admission estimated glomerular filtration rates (eGFR) equivalent to or greater than 45 ml/min/1.73 m(2) and who survived hospitalization. After controlling for potential confounders such as baseline level of eGFR and diabetes status, dialysis-requiring ARF was independently associated with a 28-fold increase in the risk of developing stage 4 or 5 CKD and more than a twofold increased risk of death. Our study shows that in a large, community-based cohort of patients with pre-existing normal or near normal kidney function, an episode of dialysis-requiring ARF was a strong independent risk factor for a long-term risk of progressive CKD and mortality.

Figure 1

Outcomes among 562,779 hospitalized patients with preadmission estimated glomerular filtration rate (GFR)⩾45 ml/min per 1.73 m². ESRD, end-stage renal disease.

Figure 2

Kaplan-Meier curves showing long-term risk of progressive chronic kidney disease (CKD) (stage 4 or higher) among patients who did (dashed line) or did not (solid line) suffer acute renal failure.