Dr. Dalal
Clinical question: Is acute kidney injury (AKI) associated with subsequent worsening of renal function trajectory in patients with chronic kidney disease (CKD)?
Background: Prior research has indicated that AKIs may lead to long-term renal function decline, and this has led to changes in clinical practice, funding, research focus, and even public health initiatives. However, those studies had methodologic limitations such as inadequate control for differences between patients with or without an AKI, and insufficient consideration of pre-AKI estimated glomerular filtration rate (eGFR), proteinuria, or eGFR slope.
Study design: Multicenter prospective cohort study
Setting: U.S.
Synopsis: This study evaluated 3,150 racially and ethnically diverse CKD patients using a linear mixed-effects regression model that adjusted for factors, such as pre-AKI eGFR and proteinuria, to assess post-AKI eGFR trajectory with measurements at annual study visits. There were 612 episodes of AKI among 433 patients in a 3.9-year median follow-up. After adjusting for pre-AKI factors, AKI was not independently associated with worsened kidney function. The findings suggest that decline in renal function after AKI is more likely attributable to pre-AKI factors and, thus, the focus should shift towards early treatment of CKD and proteinuria. Limitations included a lack of evaluation of the etiology of AKI or use of nephrotoxic medications after AKI, and a small number of severe AKI cases.
Bottom line: Mild to moderate AKI may have limited effect on subsequent renal function trajectory in patients with CKD.
Citation: Muiru AN, Hsu JY, et al. Risk for chronic kidney disease progression after acute kidney injury: Findings from the chronic renal insufficiency cohort study. Ann Intern Med. 2023;176(7):961-8.
Dr. Dalal is co-director of hospital education programs at Johns Hopkins Hospital and an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore.