학술논문
Association Between Early Recovery of Kidney Function After Acute Kidney Injury and Long-term Clinical Outcomes.
Document Type
Academic Journal
Author
Bhatraju PK; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle.; Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle.; Zelnick LR; Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle.; Chinchilli VM; Penn State College of Medicine, Department of Public Health Sciences, Hershey, Pennsylvania.; Moledina DG; Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Program of Applied Translational Research, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Coca SG; Section of Nephrology, Department of Internal Medicine, Mount Sinai School of Medicine, New York, New York.; Parikh CR; Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.; Garg AX; Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.; Hsu CY; Division of Nephrology, Department of Medicine, University of California, San Francisco.; Division of Research, Kaiser Permanente Northern California, Oakland.; Go AS; Division of Nephrology, Department of Medicine, University of California, San Francisco.; Division of Research, Kaiser Permanente Northern California, Oakland.; Department of Epidemiology and Biostatistics, University of California, San Francisco.; Liu KD; Division of Nephrology, Department of Medicine, University of California, San Francisco.; Division of Critical Care, Department of Anesthesia, University of California, San Francisco.; Ikizler TA; Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.; Siew ED; Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.; Kaufman JS; Division of Nephrology, New York University School of Medicine, New York.; Division of Nephrology, Veterans Affairs New York Harbor Healthcare System, New York.; Kimmel PL; Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC.; Himmelfarb J; Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle.; Wurfel MM; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle.; Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle.
Source
Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
Subject
Language
English
Abstract
Importance: The severity of acute kidney injury (AKI) is usually determined based on the maximum serum creatinine concentration. However, the trajectory of kidney function recovery could be an additional important dimension of AKI severity.
Objective: To assess whether the trajectory of kidney function recovery within 72 hours after AKI is associated with long-term risk of clinical outcomes.
Design, Setting, and Participants: This prospective, multicenter cohort study enrolled 1538 adults with or without AKI 3 months after hospital discharge between December 1, 2009, and February 28, 2015. Statistical analyses were completed November 1, 2018. Participants with or without AKI were matched based on demographic characteristics, site, comorbidities, and prehospitalization estimated glomerular filtration rate. Participants with AKI were classified as having resolving or nonresolving AKI based on previously published definitions. Resolving AKI was defined as a decrease in serum creatinine concentration of 0.3 mg/dL or more or 25% or more from maximum in the first 72 hours after AKI diagnosis. Nonresolving AKI was defined as AKI not meeting the definition for resolving AKI.
Main Outcomes and Measures: The primary outcome was a composite of major adverse kidney events (MAKE), defined as incident or progressive chronic kidney disease, long-term dialysis, or all-cause death during study follow-up.
Results: Among 1538 participants (964 men; mean [SD] age, 64.6 [12.7] years), 769 (50%) had no AKI, 475 (31%) had a resolving AKI pattern, and 294 (19%) had a nonresolving AKI pattern. After a median follow-up of 4.7 years, the outcome of MAKE occurred in 550 (36%) of all participants. The adjusted hazard ratio for MAKE was higher for patients with resolving AKI (adjusted hazard ratio, 1.52; 95% CI, 1.01-2.29; P = .04) and those with nonresolving AKI (adjusted hazard ratio 2.30; 95% CI, 1.52-3.48; P < .001) compared with participants without AKI. Within the population of patients with AKI, nonresolving AKI was associated with a 51% greater risk of MAKE (95% CI, 22%-88%; P < .001) compared with resolving AKI. The higher risk of MAKE among patients with nonresolving AKI was explained by a higher risk of incident and progressive chronic kidney disease.
Conclusions and Relevance: This study suggests that the 72-hour period immediately after AKI distinguishes the risk of clinically important kidney-specific long-term outcomes. The identification of different AKI recovery patterns may improve patient risk stratification, facilitate prognostic enrichment in clinical trials, and enable recognition of patients who may benefit from nephrology consultation.
Objective: To assess whether the trajectory of kidney function recovery within 72 hours after AKI is associated with long-term risk of clinical outcomes.
Design, Setting, and Participants: This prospective, multicenter cohort study enrolled 1538 adults with or without AKI 3 months after hospital discharge between December 1, 2009, and February 28, 2015. Statistical analyses were completed November 1, 2018. Participants with or without AKI were matched based on demographic characteristics, site, comorbidities, and prehospitalization estimated glomerular filtration rate. Participants with AKI were classified as having resolving or nonresolving AKI based on previously published definitions. Resolving AKI was defined as a decrease in serum creatinine concentration of 0.3 mg/dL or more or 25% or more from maximum in the first 72 hours after AKI diagnosis. Nonresolving AKI was defined as AKI not meeting the definition for resolving AKI.
Main Outcomes and Measures: The primary outcome was a composite of major adverse kidney events (MAKE), defined as incident or progressive chronic kidney disease, long-term dialysis, or all-cause death during study follow-up.
Results: Among 1538 participants (964 men; mean [SD] age, 64.6 [12.7] years), 769 (50%) had no AKI, 475 (31%) had a resolving AKI pattern, and 294 (19%) had a nonresolving AKI pattern. After a median follow-up of 4.7 years, the outcome of MAKE occurred in 550 (36%) of all participants. The adjusted hazard ratio for MAKE was higher for patients with resolving AKI (adjusted hazard ratio, 1.52; 95% CI, 1.01-2.29; P = .04) and those with nonresolving AKI (adjusted hazard ratio 2.30; 95% CI, 1.52-3.48; P < .001) compared with participants without AKI. Within the population of patients with AKI, nonresolving AKI was associated with a 51% greater risk of MAKE (95% CI, 22%-88%; P < .001) compared with resolving AKI. The higher risk of MAKE among patients with nonresolving AKI was explained by a higher risk of incident and progressive chronic kidney disease.
Conclusions and Relevance: This study suggests that the 72-hour period immediately after AKI distinguishes the risk of clinically important kidney-specific long-term outcomes. The identification of different AKI recovery patterns may improve patient risk stratification, facilitate prognostic enrichment in clinical trials, and enable recognition of patients who may benefit from nephrology consultation.