Albuminuria and Estimated Glomerular Filtration Rate Independently Associate with Acute Kidney Injury

Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Journal of the American Society of Nephrology (Impact Factor: 9.34). 10/2010; 21(10):1757-64. DOI: 10.1681/ASN.2010010128
Source: PubMed


Acute kidney injury (AKI) is increasingly common and a significant contributor to excess death in hospitalized patients. CKD is an established risk factor for AKI; however, the independent graded association of urine albumin excretion with AKI is unknown. We analyzed a prospective cohort of 11,200 participants in the Atherosclerosis Risk in Communities (ARIC) study for the association between baseline urine albumin-to-creatinine ratio and estimated GFR (eGFR) with hospitalizations or death with AKI. The incidence of AKI events was 4.0 per 1000 person-years of follow-up. Using participants with urine albumin-to-creatinine ratios <10 mg/g as a reference, the relative hazards of AKI, adjusted for age, gender, race, cardiovascular risk factors, and categories of eGFR were 1.9 (95% CI, 1.4 to 2.6), 2.2 (95% CI, 1.6 to 3.0), and 4.8 (95% CI, 3.2 to 7.2) for urine albumin-to-creatinine ratio groups of 11 to 29 mg/g, 30 to 299 mg/g, and ≥300 mg/g, respectively. Similarly, the overall adjusted relative hazard of AKI increased with decreasing eGFR. Patterns persisted within subgroups of age, race, and gender. In summary, albuminuria and eGFR have strong, independent associations with incident AKI.

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    • "Chronic kidney disease (CKD) represents a large burden among affected patients and on the healthcare system in the U.S. Approximately 26 million U.S. individuals have impaired kidney function or albuminuria [1]; the majority of these patients also have other significant co-morbid conditions such as diabetes mellitus, hypertension and cardiovascular disease [2]. Patients with CKD have significantly higher risk for hospital admissions [3-5], acute kidney injury [6], and cardiovascular-related death [7]. Moreover, CKD-associated costs have increased significantly, with CKD comprising 5.8% in 2000 to now 16% in 2009 of total Medicare costs. "
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    • "The Atherosclerosis Risk in Communities study enrolled 11,200 patients in order to evaluate the relationship between proteinuria and AKI. The results showed that the risk of AKI increased with the severity of albuminuria [30]. Although clinicians have exerted efforts to prevent cisplatin-induced AKI, the results are not satisfactory [7]. "
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