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Medline ® Abstract for Reference 26

of 'Kidney and patient outcomes after acute kidney injury in adults'

Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge.
Pannu N, James M, Hemmelgarn B, Klarenbach S, Alberta Kidney Disease Network
Clin J Am Soc Nephrol. 2013;8(2):194. Epub 2012 Nov 2.
BACKGROUND AND OBJECTIVES: This study aimed to determine if recovery of kidney function after AKI modifies the association between AKI during hospitalization and adverse outcomes after discharge.
DESIGN, SETTING, PARTICIPANTS,&MEASUREMENTS: The effect of renal recovery after AKI was evaluated in a population-based cohort study (n=190,714) with participants identified from a provincial claims registry in Alberta, Canada, between November 1, 2002 and December 31, 2007. AKI was identified by a two-fold increase between prehospital and peak in-hospital serum creatinine (SCr). Recovery was assessed using SCr drawn closest to 90 days after the AKI event. All-cause mortality and a combined renal outcome of sustained doubling of SCr or progression to kidney failure were evaluated.
RESULTS: Overall, 3.7% of the participants (n=7014) had AKI, 62.7% of whom (n=4400) survived 90 days. In the 3231 patients in whom recovery could be assessed over a median follow-up of 34 months, 30.8% (n=1268) of AKI survivors died and 2.1% (n=85) progressed to kidney failure. Participants who did notrecover kidney function had a higher risk for mortality and adverse renal outcomes when AKI participants who recovered to within 25% of baseline SCr were used as the reference group (adjusted mortality hazard ratio (HR), 1.26; 95% confidence interval, 1.10, 1.43) (adjusted renal outcomes HR, 4.13; 95% confidence interval, 3.38, 5.04). Mortality HR was notably higher when participants failed to recover within 55% of baseline.
CONCLUSIONS: Renal recovery after AKI is associated with a lower risk of death or adverse renal outcomes after hospital discharge.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. npannu@ualberta.ca