• Michael Heung, Diane E Steffick, Kara Zivin, Brenda W Gillespie, Tanushree Banerjee, Chi-Yuan Hsu, Neil R Powe, Meda E Pavkov, Desmond E Williams, Rajiv Saran, Vahakn B Shahinian, and Centers for Disease Control and Prevention CKD Surveillance Team.
• Kidney Epidemiology and Cost Center, Ann Arbor, MI. Electronic address: mheung@umich.edu.
• Am. J. Kidney Dis. 2016 May 1; 67 (5): 742-52.

BackgroundStudies suggest an association between acute kidney injury (AKI) and long-term risk for chronic kidney disease (CKD), even following apparent renal recovery. Whether the pattern of renal recovery predicts kidney risk following AKI is unknown.Study DesignRetrospective cohort.Setting & ParticipantsPatients in the Veterans Health Administration in 2011 hospitalized (> 24 hours) with at least 2 inpatient serum creatinine measurements, baseline estimated glomerular filtration rate > 60 mL/min/1.73 m², and no diagnosis of end-stage renal disease or non-dialysis-dependent CKD: 17,049 (16.3%) with and 87,715 without AKI.PredictorPattern of recovery to creatinine level within 0.3 mg/dL of baseline after AKI: within 2 days (fast), in 3 to 10 days (intermediate), and no recovery by 10 days (slow or unknown).OutcomeCKD stage 3 or higher, defined as 2 outpatient estimated glomerular filtration rates < 60 mL/min/1.73m² at least 90 days apart or CKD diagnosis, dialysis therapy, or transplantation.MeasurementsRisk for CKD was modeled using modified Poisson regression and time to death-censored CKD was modeled using Cox proportional hazards regression, both stratified by AKI stage.ResultsMost patients' AKI episodes were stage 1 (91%) and 71% recovered within 2 days. At 1 year, 18.2% had developed CKD (AKI, 31.8%; non-AKI, 15.5%; P < 0.001). In stage 1, the adjusted relative risk ratios for CKD stage 3 or higher were 1.43 (95% CI, 1.39-1.48), 2.00 (95% CI, 1.88-2.12), and 2.65 (95% CI, 2.51-2.80) for fast, intermediate, and slow/unknown recovery. A similar pattern was observed in subgroup analyses incorporating albuminuria and sensitivity analysis of death-censored time to CKD.LimitationsVariable timing of follow-up and mostly male veteran cohort may limit generalizability.ConclusionsPatients who develop AKI during a hospitalization are at substantial risk for the development of CKD by 1 year following hospitalization and timing of AKI recovery is a strong predictor, even for the mildest forms of AKI.Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.

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