Association of Acute Kidney Injury with Progression to Acute and Chronic Kidney Disease

San Diego—There are strong ties between acute kidney injury (AKI) and the pathogenesis of chronic kidney disease (CKD), and between AKI and increased risks for hospital readmission, progression to end-stage renal disease, and mortality. Acute kidney disease (AKD) is the bridge between AKI and CKD, and may represent a potentially modifiable stage in the progression of kidney disease.

Kevin Ho, MD, and colleagues at the Geisinger Medical Center, Danville, Pennsylvania, recently conducted a retrospective analysis of hospitalization data from the Geisinger electronic health records from 2013 through 2017, including baseline serum creatinine and estimated glomerular filtration rate (eGFR) values for the 12 to 18 months prior to hospital admission. Results of the analysis were presented during a poster session at Kidney Week 2018 in a poster titled Transition of Hospital-Acquired AKI to Acute Kidney Disease and CKD.

The researchers examined AKI events with a duration of ≤7 days using National Kidney Foundation Kidney Disease Outcomes Quality Initiative criteria, length of stay, AKD (defined as persistent AKI based on serum creatinine during days 8 to 89 following the start date of AKI), incident CKD (defined as eGFR <60 mL/min/1.73 m2), and progression of CKD (defined as eGFR ≥5 mL/min/1.73 m2 below baseline).

During the study period, there were 282,418 patient admissions. Of those, 53,741 hospital admissions were characterized by AKI events (19.0%). Length of stay was increased by AKI events (5.8 days) and exceeded 7 days in 24.7% of admissions with AKI events compared with length of stay of 3.7 days in patients without AKI. In 38.2% of admissions with AKI events, AKI transitioned to AKD.

Among the 35,190 patients admitted with a baseline eGFR of ≥60 mL/min/1.73 m2, 18.8% developed incident CKD following either AKI or AKD within 1 year of the AKI start date. After combining AKI and AKD occurrences in patients with baseline CKD prior to admission status (n=9245), 29.0% exhibited post-AKI/AKD progression of their CKD within 1 year of the AKI event.

“Hospital-acquired acute kidney injury is observed to occur in conjunction with increased hospital length of stay, a relatively high transition rate to acute kidney disease, and both incident and progression of chronic kidney disease within 1 year of an event. Close clinical follow-up of AKI survivors is needed to promote renal recovery and/or delay progression of kidney disease,” the researchers said.

Source: Ho K, Riviello D, Brown J, et al. Transition of hospital-acquired AKI to acute kidney disease and chronic kidney disease. Abstract of a poster (TH-PO006) presented at the American Society of Nephrology Kidney Week 2018, October 25, 2018, San Diego, California.