Acute Kidney Injury Increases Risk of ESRD among Elderly

United States Renal Data System Coordinating Center and Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota 55404, USA.
Journal of the American Society of Nephrology (Impact Factor: 9.34). 11/2008; 20(1):223-8. DOI: 10.1681/ASN.2007080837
Source: PubMed


Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged > or = 67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for > or = 2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% CI 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% CI 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease.

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    • "Although renal recovery from AKI is associated with better renal outcomes and patient survival [10], no differences in long-term survival between those with kidney function recovery after AKI and those without AKI were observed in two population-based cohorts [11] [12]. However, in postoperative patients [13] [14] [15] and geriatric patients [16], temporary worsening of kidney function has been reported with a higher long-term mortality rate compared with non- AKI patients. The cohorts in previous reports have mostly focused on preexisting normal or near normal kidney function [9, 17–19] or all patients with chronic kidney disease (CKD) [8]. "
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    ABSTRACT: AKI-dialysis patients had a higher incidence of long-term ESRD and mortality than the patients without AKI. The patients who recovered from dialysis were associated with a lower incidence of long-term ESRD and mortality than in the patients who still required dialysis.
    BioMed Research International 08/2014; 2014:365186. DOI:10.1155/2014/365186 · 1.58 Impact Factor
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    • "Similar to our report, studies by Stads et al. [17], Ishani et al. [18], and Lo et al. [3] have demonstrated the strong association between pre-existing CKD and the need for subsequent chronic dialysis. It is not surprising that pre-existing CKD is one of the most important predictors modifying the relationship between AKI and progressive CKD as has been demonstrated in multiple studies [19-22]. "
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    ABSTRACT: Background Survivors of acute kidney injury are at an increased risk of developing irreversible deterioration in kidney function and in some cases, the need for chronic dialysis. We aimed to determine predictors of chronic dialysis and death among survivors of dialysis-requiring acute kidney injury. Methods We used linked administrative databases in Ontario, Canada, to identify patients who were discharged from hospital after an episode of acute kidney injury requiring dialysis and remained free of further dialysis for at least 90 days after discharge between 1996 and 2009. Follow-up extended until March 31, 2011. The primary outcome was progression to chronic dialysis. Predictors for this outcome were evaluated using cause-specific Cox proportional hazards models, and a competing risk approach was used to calculate absolute risk. Results We identified 4 383 patients with acute kidney injury requiring temporary in-hospital dialysis who survived to discharge. After a mean follow-up of 2.4 years, 356 (8%) patients initiated chronic dialysis and 1475 (34%) died. The cumulative risk of chronic dialysis was 13.5% by the Kaplan-Meier method, and 10.3% using a competing risk approach. After accounting for the competing risk of death, previous nephrology consultation (subdistribution hazard ratio (sHR) 2.03; 95% confidence interval (CI) 1.61-2.58), a history of chronic kidney disease (sHR3.86; 95% CI 2.99-4.98), a higher Charlson comorbidity index score (sHR 1.10; 95% CI 1.05-1.15/per unit) and pre-existing hypertension (sHR 1.82; 95% CI 1.28-2.58) were significantly associated with an increased risk of progression to chronic dialysis. Conclusions Among survivors of dialysis-requiring acute kidney injury who initially become dialysis independent, the subsequent need for chronic dialysis is predicted by pre-existing kidney disease, hypertension and global comorbidity. This information can identify patients at high risk of progressive kidney disease who may benefit from closer surveillance after cessation of the acute phase of illness.
    BMC Nephrology 07/2014; 15(1):114. DOI:10.1186/1471-2369-15-114 · 1.69 Impact Factor
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    • "The terminal stage of this condition, end stage renal disease (ESRD), is a serious health outcome which carries high economic and social costs, requiring renal replacement therapy in the form of dialysis or transplantation in order to sustain life. The number of people with end-stage renal disease starting renal replacement therapy has increased worldwide in recent years, with a progressive increase in the proportion being elderly [1,2]. In high-income countries, end-stage renal disease accounts for a substantial share of health care spending and is one of the major contributors to rising health care costs. "
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    ABSTRACT: Background Chronic kidney disease has become a public health problem worldwide. Its terminal stage requires renal replacement therapy – dialysis or transplantation – for the maintenance of life, resulting in high economic and social costs. Though the number of patients with end-stage renal disease treated by dialysis in Brazil is among the highest in the world, current estimates of incidence and prevalence are imprecise. Our aim is to describe incidence and prevalence trends and the epidemiologic profile of end-stage renal disease patients receiving publically-financed dialysis in Brazil between 2000 and 2012. Methods We internally linked records of the High Complexity Procedure Authorization/Renal Replacement Therapy (APAC/TRS) system so as to permit analyses of incidence and prevalence of dialysis over the period 2000-2012. We characterized temporal variations in the incidence and prevalence using Joinpoint regression. Results Over the period, 280,667 patients received publically-financed dialysis, 57.2% of these being male. The underlying disease causes listed were hypertension (20.8%), diabetes (12.0%) and glomerulonephritis (7.7%); for 42.3%, no specific cause was recorded. Hemodialysis was the therapeutic modality in 90.1%. Over this period, prevalence increased 47%, rising 3.6% (95% CI 3.2% - 4.0%)/year. Incidence increased 20%, or 1.8% (1.1% – 2.5%)/year. Incidence increased in both sexes, in all regions of the country and particularly in older age groups. Conclusions Incidence and prevalence of end-stage renal disease receiving publically-financed dialysis treatment has increased notably. The linkage approach developed will permit continuous future monitoring of these indicators.
    BMC Nephrology 07/2014; 15(1):111. DOI:10.1186/1471-2369-15-111 · 1.69 Impact Factor
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