Kidney international
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Kidney international · Oct 2009
CommentUremic memory: the role of acute kidney injury in long-term outcomes.
Most epidemiologic data, thus far, have focused on short-term outcomes of acute kidney injury (AKI). Lo et al. correlate AKI with long-term outcomes. The concept of 'uremic memory' sheds light on the importance of AKI and its permanent imprint. The focus of research should be on prevention of an episode of AKI, when possible.
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Kidney international · Oct 2009
Comparative StudyThe impact of transient and persistent acute kidney injury on long-term outcomes after acute myocardial infarction.
Acute kidney injury is a common complication of acute myocardial infarction and is generally associated with adverse outcomes. We studied the incidence and clinical significance of transient versus persistent acute kidney injury in 1957 patients who survived an ST-elevation acute myocardial infarction. We divided the patients into 5 groups based on changes in serum creatinine level during hospitalization. ⋯ Patients with persistent moderate/severe acute kidney injury had the highest mortality (hazard ratio 2.4), whereas patients with transient moderate/severe injury had an intermediate risk (hazard ratio of 1.7). A similar relationship was present between acute kidney injury and admissions for heart failure. Our study shows that dynamic changes in renal function during acute myocardial infarction are strongly related to long-term mortality and heart failure.
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Kidney international · Oct 2009
Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease.
To determine whether acute renal failure (ARF) increases the long-term risk of progressive chronic kidney disease (CKD), we studied the outcome of patients whose initial kidney function was normal or near normal but who had an episode of dialysis-requiring ARF and did not develop end-stage renal disease within 30 days following hospital discharge. The study encompassed 556,090 adult members of Kaiser Permanente of Northern California hospitalized over an 8 year period, who had pre-admission estimated glomerular filtration rates (eGFR) equivalent to or greater than 45 ml/min/1.73 m(2) and who survived hospitalization. After controlling for potential confounders such as baseline level of eGFR and diabetes status, dialysis-requiring ARF was independently associated with a 28-fold increase in the risk of developing stage 4 or 5 CKD and more than a twofold increased risk of death. Our study shows that in a large, community-based cohort of patients with pre-existing normal or near normal kidney function, an episode of dialysis-requiring ARF was a strong independent risk factor for a long-term risk of progressive CKD and mortality.
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Kidney international · Oct 2009
A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery.
To predict development of acute kidney injury and its outcome we retrospectively studied children having cardiac surgery. Acute kidney injury (AKI) was defined using the serum creatinine criteria of the pediatric Risk Injury Failure Loss End-Stage (pRIFLE) kidney disease definition. We tested whether a small rise (less than 50%) in creatinine on post-operative days 1 or 2 could predict a greater than 50% increase in serum creatinine within 48 h in 390 children. ⋯ Percentage serum creatinine rise on post-operative day 1 predicted AKI within 48 h (area under the curve=0.65). Our study shows that AKI after pediatric heart surgery is common and is a risk factor for poorer outcome. Small post-operative increases in serum creatinine may assist in the early prediction of AKI.