The severity of acute kidney injury predicts progression to chronic kidney disease

By L. Chawla, R. Amdur, S. Amodeo, P. Kimmel, C. Palant. Kidney International, 2011

662 citations recorded by the source corpus.

Acute kidney injury (AKI) is associated with progression to advanced chronic kidney disease (CKD). We tested whether patients who survive AKI and are at higher risk for CKD progression can be identified during their hospital admission, thus providing opportunities to intervene. This was assessed in patients in the Department of Veterans Affairs Healthcare System hospitalized with a primary diagnosis indicating AKI (ICD9 codes 584.xx). In the exploratory phase, three multivariate prediction models for progression to stage 4 CKD were developed. In the confirmatory phase, the models were validated in 11,589 patients admitted for myocardial infarction or pneumonia during the same time frame that had RIFLE codes R, I, or F and complete data for all predictor variables. Of the 5351 patients in the AKI group, 728 entered stage 4 CKD after hospitalization. Models 1, 2, and 3 were all significant with ‘c' statistics of 0.82, 0.81, and 0.77, respectively. In model validation, all three were highly significant when tested in the confirmatory patients, with moderate to large effect sizes and good predictive accuracy (‘c' 0.81–0.82). Patients with AKI who required dialysis and then recovered were at especially high risk for progression to CKD. Hence, the severity of AKI is a robust predictor of progression to CKD.

Subfields: Emergency Medicine, Nephrology

View Paper: https://www.semanticscholar.org/paper/31803e64d47c4931871aec9ec8f62684d2f29635

How researchers see this paper

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In Emergency Medicine

1. L. Chawla
2. P. Kimmel
3. Jorge Cerdá
4. R. Mehta
5. A. Lewington

In Nephrology

1. L. Chawla
2. P. Kimmel
3. Jorge Cerdá
4. R. Mehta
5. A. Lewington

Citations in the corpus

• Raising Awareness of Acute Kidney Injury: A Global Perspective of a Silent Killer (2013, background): “Several studies have confirmed that while the course of AKI is variable based on the setting where it occurs, the severity and duration of AKI determines outcomes, including dialysis requirement, renal functional recovery and survival (4, 5).”
• Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. (2012, methodology): “In addition to these risk factors, along with our colleagues, we recently showed that low serum albumin concentration (SAlb) is a strong predictor of poor long-term renal outcome.(9) The value of the SAlb as a predictor of CKD progression is not surprising, because this parameter has been associated”