A study of hospitalized individuals with chronic kidney disease (CKD) fournd that acute kidney injury (AKI) didn’t predict worsening of kidney function trajectory once difference in pre-hospitalization characteristically were fully accounted for. As an alternative, the authors suggest that much of determinants of faster kidney disease decline observed after AKI may already be present before AKI. The findings are published in Annals of Internal Medicine.

Many now imagine that AKI is an independent risk factor for accelerated lack of kidney function. This has led to changes in research focus, practice patterns, and public health targets. Nevertheless, prior studies associating AKI with more rapid subsequent lack of kidney function had methodological limitations, including inadequate control for differences between patients who had AKI and people who didn’t.

Researchers from the University of California, San Francisco and colleagues within the Chronic Renal Insufficiency Cohort (CRIC study) analyzed data from 3,150 individuals with CKD to find out whether AKI is independently related to subsequent kidney function trajectory. The information showed 612 AKIs in 433 individuals with CKD over a median follow-up of three.9 years. After adjusting for patient characteristics, reminiscent of prehospitalization estimated glomerular filtration rate (eGFR) slope and level of proteinuria, AKI didn’t predict worsening of subsequent kidney function trajectory. As an alternative, the authors highlight that their results show that much of the kidney disease observed after AKI may already be present before AKI. They recommend that clinicians as a substitute concentrate on flattening the eGFR slope and treating proteinuria. The authors do acknowledge that a diagnosis of AKI does present a possibility to discover high-risk patients and implement evidence-based interventions to slow CKD progression.

Source:

American College of Physicians

Journal reference:

Muiru, A. N., et al. (2023) Risk for Chronic Kidney Disease Progression After Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort Study. Annals of Internal Medicine. doi.org/10.7326/M22-3617.