Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysis
Received 18 September 2008; accepted 28 November 2008. published online 06 April 2009.
Refers to article:
Long-term Outcomes After Acute Kidney Injury: Where We Stand and How We Can Move Forward
, 23 March 2009
Lowell Lo, Kathleen D. Liu, Chi-yuan Hsu
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 928-931) Full Text |
Full-Text PDF (144 KB)
Background
Acute kidney injury (AKI) is common in hospitalized patients. The impact of AKI on long-term outcomes is controversial.
Study Design
Systematic review and meta-analysis.
Setting & Participants
Persons with AKI.
Selection Criteria for Studies
MEDLINE and EMBASE databases were searched from 1985 through October 2007. Original studies describing outcomes of AKI for patients who survived hospital discharge were included. Studies were excluded from review when participants were followed up for less than 6 months.
Predictor
AKI, defined as acute changes in serum creatinine level or acute need for renal replacement therapy.
Outcomes
Chronic kidney disease (CKD), cardiovascular disease, and mortality.
Results
48 studies that contained a total of 47,017 participants were reviewed; 15 studies reported long-term data for patients without AKI. The incidence rate of mortality was 8.9 deaths/100 person-years in survivors of AKI and 4.3 deaths/100 patient-years in survivors without AKI (rate ratio [RR], 2.59; 95% confidence interval, 1.97 to 3.42). AKI was associated independently with mortality risk in 6 of 6 studies that performed multivariate adjustment (adjusted RR, 1.6 to 3.9) and with myocardial infarction in 2 of 2 studies (RR, 2.05; 95% confidence interval, 1.61 to 2.61). The incidence rate of CKD after an episode of AKI was 7.8 events/100 patient-years, and the rate of end-stage renal disease was 4.9 events/100 patient-years.
Limitations
The relative risk for CKD and end-stage renal disease after AKI was unattainable because of lack of follow-up of appropriate controls without AKI.
Conclusions
The development of AKI, defined as acute changes in serum creatinine level, characterizes hospitalized patients at increased risk of long-term adverse outcomes.
5University of Western Ontario, London, Ontaria, Canada
Address correspondence to Chirag Parikh, MD, PhD, Section of Nephrology, Yale University and VAMC, 950 Campbell Ave, Mail Code 151B, Bldg 35 A, Rm 219, West Haven, CT 06516
ABSTRACT