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. 2011 Nov;6(11):2567-72.
doi: 10.2215/CJN.01120211. Epub 2011 Sep 8.

Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus

Charuhas V Thakar  1 , Annette Christianson, Jonathan Himmelfarb, Anthony C Leonard
Affiliations

Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus

Charuhas V Thakar et al. Clin J Am Soc Nephrol. 2011 Nov.

Abstract

Background and objectives: Prior studies have examined long-term outcomes of a single acute kidney injury (AKI) event in hospitalized patients. We examined the effects of AKI episodes during multiple hospitalizations on the risk of chronic kidney disease (CKD) in a cohort with diabetes mellitus (DM).

Design, setting, participants, & measurements: A total of 4082 diabetics were followed from January 1999 until December 2008. The primary outcome was reaching stage 4 CKD (GFR of <30 ml/min per 1.73 m(2)). AKI during hospitalization was defined as >0.3 mg/dl or a 1.5-fold increase in creatinine relative to admission. Cox survival models examined the effect of first AKI episode and up to three episodes as time-dependent covariates, on the risk of stage 4 CKD. Covariates included demographic variables, baseline creatinine, and diagnoses of comorbidities including proteinuria.

Results: Of the 3679 patients who met eligibility criteria (mean age = 61.7 years [SD, 11.2]; mean baseline creatinine = 1.10 mg/dl [SD, 0.3]), 1822 required at least one hospitalization during the time under observation (mean = 61.2 months [SD, 25]). Five hundred thirty of 1822 patients experienced one AKI episode; 157 of 530 experienced ≥2 AKI episodes. In multivariable Cox proportional hazards models, any AKI versus no AKI was a risk factor for stage 4 CKD (hazard ratio [HR], 3.56; 95% confidence interval [CI], 2.76, 4.61); each AKI episode doubled that risk (HR, 2.02; 95% CI, 1.78, 2.30).

Conclusions: AKI episodes are associated with a cumulative risk for developing advanced CKD in diabetes mellitus, independent of other major risk factors of progression.

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Figures

Figure 1.
Figure 1.
Frequency of reaching stage 4 chronic kidney disease (CKD) by patient groups.
Figure 2.
Figure 2.
(A) Survival to stage 4 CKD in no AKI versus AKI groups. (B) Survival to stage 4 CKD in no AKI versus multiple AKI episode group. CKD, chronic kidney disease; AKI, acute kidney injury.
Figure 3.
Figure 3.
Survival to stage 4 chronic kidney disease (CKD) in AKI versus no AKI groups, by strata of baseline level of estimated GFR. CKD, chronic kidney disease; AKI, acute kidney injury.
Figure 4.
Figure 4.
Frequency of all-cause mortality by patient groups.
See this image and copyright information in PMC

Comment in

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