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Abstract: FR-PO032

The Risk of Major Adverse Kidney Events After AKI: A Systematic Review and Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • See, Emily J., Princess Alexandra Hospital, Greenslopes, Queensland, Australia
  • Jayasinghe, Kushani C., Monash Health, Clayton, New South Wales, Australia
  • Johnson, David W., Princess Alexandra Hospital, Greenslopes, Queensland, Australia
  • Polkinghorne, Kevan, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
  • Toussaint, Nigel David, The Royal Melbourne Hospital, Parkville, Victoria, Australia

Acute kidney injury (AKI) is a common consequence of acute illness and is associated with high morbidity and mortality. Robust estimates of the long-term outcomes of AKI, using consensus definitions of exposure, are needed to inform clinical practice and guide optimal allocation of healthcare resources.


A systematic search was performed through EMBASE, MEDLINE, and grey literature sources to identify cohort studies reporting an association between AKI and chronic kidney disease (CKD), end-stage kidney disease (ESKD) or death. All studies published between 2004 and 2018 involving hospitalised adults were eligible if they defined AKI according to consensus definitions (RIFLE, AKIN, or KDIGO), included a non-AKI control group, and followed patients for at least 1 year. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random effects meta-analysis was used to combine adjusted hazard ratios between studies. Subgroup, sensitivity and meta-regression analyses were performed to investigate potential sources of heterogeneity.


The systematic search retrieved 6369 citations, of which 81 studies comprising more than 2 million participants were eligible for inclusion. One-third of studies were in cardiovascular surgery patients and one-third were performed in Europe. Reporting of methods was incomplete in many studies. The most common sources of bias were poor representativeness of patient cohorts, and insufficient duration and completeness of follow up. Funnel plot asymmetry reflected a lack of small studies with negative effects.

AKI was associated with a significantly increased risk of death across all subgroups: angiography (HR 3.07, 95%CI 2.12-4.46), cardiovascular surgery (HR 1.75, 95%CI 1.55-1.98), intensive care (HR 1.47, 95%CI 1.32-1.65), and hospital (HR 1.41, 95%CI 1.26-1.56). The risk of death increased from stage 1 (HR 1.35, 95%CI 1.27-1.44) to stage 3 (HR 2.76, 95%CI 2.28-3.35). AKI was associated with increased risks of CKD (HR 2.86, 95%CI 2.09-3.91) and ESKD (HR 4.81, 95%CI 3.04-7.62). Heterogeneity between studies was high.


AKI was associated with inferior long-term survival and an increased risk of adverse renal outcomes. The risk of a poort outcome increased with greater AKI severity. Patients undergoing angiography and cardiovascular surgery were at greatest risk.