Three-year outcomes after acute kidney injury: results of a prospective parallel group cohort study

Horne, Kerry L.; Packington, Rebecca; Monaghan, John; Reilly, Timothy; Selby, Nicholas M.

Abstract

Objectives Using a prospective study design, we aimed to characterise the effect of acute kidney injury (AKI) on long-term changes in renal function in a general hospital population.

Participants Hospitalised patients with AKI (exposed) and hospitalised patients without AKI (non-exposed), recruited at 3 months after hospital admission.

Design Prospective, matched parallel group cohort study, in which renal function and proteinuria were measured at 3 months, 1 year and 3 years.

Setting Single UK centre.

Clinical end points Clinical end points at 3 years were comparison of the following variables between exposed and non-exposed groups: renal function, prevalence of proteinuria and albuminuria and chronic kidney disease (CKD) progression/development at each time point. CKD progression was defined as a decrease in the estimated glomerular filtration rate (eGFR) of ≥25% associated with a decline in eGFR stage.

Results 300 exposed and non-exposed patients were successfully matched 1:1 for age and baseline renal function; 70% of the exposed group had AKI stage 1. During follow-up, the AKI group had lower eGFR than non-exposed patients at each time point. At 3 years, the mean eGFR was 60.7±21 mL/min/1.73 m2 in the AKI group compared with 68.4±21 mL/min/1.73 m2 in the non-exposed group, p=0.003. CKD development or progression at 3 years occurred in 30 (24.6%) of the AKI group compared with 10 (7.5%) of the non-exposed group, p<0.001. Albuminuria was more common in the AKI group, and increased with AKI severity. Factors independently associated with CKD development/progression after AKI were non-recovery at 90 days, male gender, diabetes and recurrent AKI.

Conclusions AKI is associated with deterioration in renal function to 3 years, even in an unselected population with predominantly AKI stage 1. Non-recovery from AKI is an important factor determining long-term outcome.

Citation

Horne, K. L., Packington, R., Monaghan, J., Reilly, T., & Selby, N. M. (2017). Three-year outcomes after acute kidney injury: results of a prospective parallel group cohort study. BMJ Open, 7(3), Article e015316. https://doi.org/10.1136/bmjopen-2016-015316

• Journal Article Type: Article
• Acceptance Date: Feb 23, 2017
• Online Publication Date: Mar 29, 2017
• Publication Date: Mar 1, 2017
• Deposit Date: Nov 20, 2017
• Publicly Available Date: Nov 20, 2017
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 7
• Issue: 3
• Article Number: e015316
• DOI: https://doi.org/10.1136/bmjopen-2016-015316
• Public URL: https://nottingham-repository.worktribe.com/output/842889
• Publisher URL: http://bmjopen.bmj.com/content/7/3/e015316
• Contract Date: Nov 20, 2017