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Kidney Week

Abstract: FR-OR012

Relationship of Acute Kidney Disease (AKD) to Long-Term Outcomes After AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Selby, Nicholas M., University of Nottingham, Derby, United Kingdom
  • Kazmi, Isma, University of Nottingham, Derby, United Kingdom
  • Packington, Rebecca A., University Hospitals of Derby and Burton, Derby, United Kingdom
  • Monaghan, John, University Hospitals of Derby and Burton, Derby, United Kingdom

Group or Team Name

  • ARID study investigators
Background

Acute Kidney Disease (AKD) is a term that has been advocated by the Acute Disease Quality Initiative (ADQI) and others to describe ongoing renal dysfunction after AKI that persists beyond 7 days. Currently there is very little available epidemiological data regarding AKD. We sought to study its relevance to long term renal and patient outcomes.

Methods

All patients from the AKI arm of a large parallel group cohort study of AKI were included in this study. Participants were recruited following hospitalisation and followed up prospectively. Renal function, proteinuria and patient outcomes were assessed at 3 months, 1 year and 3 years after AKI. CKD progression was defined as a ≥25% decline in eGFR from baseline with a decline in eGFR stage. Patients were categorized into three groups depending on duration of AKI: AKI that resolved in <48hours (rapid recovery, r-AKI), AKI duration of 2-6 days (persistent AKI, p-AKI) and AKD (AKI duration ≥7 days). Outcomes were compared across these three groups.

Results

In total, 506 patients with AKI were studied. There were 109 (22%) in r-AKI group, 302 (60%) in p-AKI group and 95 (19%) with AKD. Patients in the AKD group had lower baseline eGFR and a higher proportion of AKI stage 3.
CKD progression was more common in AKD group as compared to other two groups. At one year, CKD progression was 46% in AKD group versus 11% (r-AKI) and 22% (p-AKI), p<0.001. eGFR was lower in AKD group at all time-points; at year 3, eGFR was 66.9±23ml/min, 60.1±20ml/min and 53±20ml/min in r-AKI, p-AKI and AKD groups respectively, p<0.001. Proteinuria was more common and more severe in AKD. Hospital readmission occurred more frequently in the AKD group.
Using binary logistic regression analysis adjusting for age, gender, diabetic status, baseline eGFR, AKI stage and biochemical variables, AKD remained independently associated with CKD progression at 1 (OR 5.4, 95% CI 2.2-13.2, p<0.001) and 3 years (OR 2.2, 95%CI 1.0-4.6, p=0.04).

Conclusion

AKD is common and is associated with a number of clinical variables including chronic comorbidities and markers of AKI severity. However, AKI duration remains an important independent determinant of subsequent progression of kidney disease, and AKD appears to be a useful way to categorize this to identify patients at higher risk of long-term adverse outcomes.