Acute Kidney Injury Episodes and Chronic Kidney Disease Risk in Diabetes Mellitus

Clinical journal of the American Society of Nephrology : CJASN - Tập 6 Số 11 - Trang 2567-2572 - 2011
Charuhas V. Thakar1,2, Annette Christianson1, Jonathan Himmelfarb3, Anthony C. Leonard2
1Cincinnati Veterans Affairs Medical Center
2Department of Internal Medicine and Department of Public Health, University of Cincinnati, OH
3Kidney Research Institute, University of Washington, Seattle, WA

Tóm tắt

Summary Background and objectives Prior studies have examined long-term outcomes of a single acute kidney injury (AKI) event in hospitalized patients. We examined the effects of AKI episodes during multiple hospitalizations on the risk of chronic kidney disease (CKD) in a cohort with diabetes mellitus (DM). Design, setting, participants, & measurements A total of 4082 diabetics were followed from January 1999 until December 2008. The primary outcome was reaching stage 4 CKD (GFR of <30 ml/min per 1.73 m2). AKI during hospitalization was defined as >0.3 mg/dl or a 1.5-fold increase in creatinine relative to admission. Cox survival models examined the effect of first AKI episode and up to three episodes as time-dependent covariates, on the risk of stage 4 CKD. Covariates included demographic variables, baseline creatinine, and diagnoses of comorbidities including proteinuria. Results Of the 3679 patients who met eligibility criteria (mean age = 61.7 years [SD, 11.2]; mean baseline creatinine = 1.10 mg/dl [SD, 0.3]), 1822 required at least one hospitalization during the time under observation (mean = 61.2 months [SD, 25]). Five hundred thirty of 1822 patients experienced one AKI episode; 157 of 530 experienced ≥2 AKI episodes. In multivariable Cox proportional hazards models, any AKI versus no AKI was a risk factor for stage 4 CKD (hazard ratio [HR], 3.56; 95% confidence interval [CI], 2.76, 4.61); each AKI episode doubled that risk (HR, 2.02; 95% CI, 1.78, 2.30). Conclusions AKI episodes are associated with a cumulative risk for developing advanced CKD in diabetes mellitus, independent of other major risk factors of progression.

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Clinical journal of the American Society of Nephrology : CJASN

Tập 6 Số 11

2567-2572

Thông tin tác giả