1. In this prospective cohort study, there was a limited association between acute kidney injury (AKI) and worsening kidney function in patients with chronic kidney disease (CKD).
2. There was no significant decrease in estimated glomerular filtration rate (eGFR) after a mild to moderate AKI in patients with CKD.
Evidence Rating Level: 1 (Excellent)
Study Rundown: AKI is typically considered a significant risk factor for the progression of loss of kidney function. However, in prior studies that examined this association, there were many methodological limitations. These include not controlling for differences between patients who had an AKI and those patients who did not. Therefore, there is a gap in knowledge as to understanding the true independent association between AKI and changes in kidney function, especially in patients with CKD. Overall, this study found that the independent association between mild to moderate AKI and worsening progressive kidney function is small and has limited clinical significance. This study was limited by participants being research volunteers and thus not generalizable to other populations. Nevertheless, these study’s findings are significant, as they demonstrate that the independent association between mild/moderate AKI and progressive worsening of kidney function in CKD patients is not as significant as previously thought.
Click to read the study in AIM
Relevant Reading: Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults
In-Depth [prospective cohort study]: This multicenter prospective cohort study evaluated patients with CKD in the United States. Patients who were alive, did not withdraw from the study, and did not develop end-stage renal disease by July 1st, 2013 were eligible for the study. Patients who did not fit these criteria were excluded from the study. The primary outcome measured was eGFR. Secondary outcome measures were the change in absolute eGFR value as well as the change in eGFR slope before and after an episode of AKI that the patient was hospitalized for. Outcomes in the primary analysis were assessed via a linear mixed-effects regression model. Based on the primary analysis, most of the AKI episodes were of mild to moderate severity. Additionally, they observed decreases in eGFRcr (-2.30; 95% Confidence Interval [CI], -3.70 to -0.86 mL/min/1.73 m2) and eGFRcys (-3.61; 95% CI, -6.39 to -0.82 mL/min/1.73 m2) after an episode of AKI. However, after adjusting for covariates in the fully adjusted models, the decreases were adjusted to -0.38 (95% CI, -1.35 to 0.59) mL/min/1.73 m2 for eGFRcr and -0.15 (95% CI, -2.16 to 1.86) mL/min/1.73 m2 for eGFRcys. In summary, this study demonstrates that subsequent worsening of kidney function in patients with CKD was small or negligible after accounting for covariates after an episode of mild to moderate AKI.
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