• Kidney international · Dec 2011

    Multicenter Study

    Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality.

    • Vin-Cent Wu, Tao-Min Huang, Chun-Fu Lai, Chih-Chung Shiao, Yu-Feng Lin, Tzong-Shinn Chu, Pei-Chen Wu, Chia-Ter Chao, Jann-Yuan Wang, Tze-Wah Kao, Guang-Huar Young, Pi-Ru Tsai, Hung-Bin Tsai, Chieh-Li Wang, Ming-Shou Wu, Wen-Chih Chiang, I-Jung Tsai, Fu-Chang Hu, Shuei-Liong Lin, Yung-Ming Chen, Tun-Jun Tsai, Wen-Je Ko, and Kwan-Dun Wu.
    • Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    • Kidney Int. 2011 Dec 1;80(11):1222-30.

    AbstractExisting chronic kidney disease (CKD) is among the most potent predictors of postoperative acute kidney injury (AKI). Here we quantified this risk in a multicenter, observational study of 9425 patients who survived to hospital discharge after major surgery. CKD was defined as a baseline estimated glomerular filtration rate <45 ml/min per 1.73 m(2). AKI was stratified according to the maximum simplified RIFLE classification at hospitalization and unresolved AKI defined as a persistent increase in serum creatinine of more than half above the baseline or the need for dialysis at discharge. A Cox proportional hazard model showed that patients with AKI-on-CKD during hospitalization had significantly worse long-term survival over a median follow-up of 4.8 years (hazard ratio, 1.7) [corrected] than patients with AKI but without CKD.The incidence of long-term dialysis was 22.4 and 0.17 per 100 person-years among patients with and without existing CKD, respectively. The adjusted hazard ratio for long-term dialysis in patients with AKI-on-CKD was 19.8 compared to patients who developed AKI without existing CKD. Furthermore, AKI-on-CKD but without kidney recovery at discharge had a worse outcome (hazard ratios of 4.6 and 213, respectively) for mortality and long-term dialysis as compared to patients without CKD or AKI. Thus, in a large cohort of postoperative patients who developed AKI, those with existing CKD were at higher risk for long-term mortality and dialysis after hospital discharge than those without. These outcomes were significantly worse in those with unresolved AKI at discharge.

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