Acute kidney disease in hospitalized acute kidney injury patients

Ping Yan; Xiang-Jie Duan; Yu Liu; Xi Wu; Ning-Ya Zhang; Fang Yuan; Hao Tang; Qian Liu; Ying-Hao Deng; Hong-Shen Wang; Mei Wang; Shao-Bin Duan

doi:10.7717/peerj.11400

Acute kidney disease in hospitalized acute kidney injury patients

PeerJ. 2021 May 24:9:e11400. doi: 10.7717/peerj.11400. eCollection 2021.

Authors

Ping Yan¹, Xiang-Jie Duan¹, Yu Liu¹, Xi Wu¹, Ning-Ya Zhang², Fang Yuan¹, Hao Tang³, Qian Liu¹, Ying-Hao Deng¹, Hong-Shen Wang¹, Mei Wang¹, Shao-Bin Duan¹

Affiliations

¹ Department of Nephrology, The Second Xiangya Hospital of Central South University; Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China.
² Information Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
³ Nutrition and Exercise Physiology, Teachers College, Columbia University, New York, United States of America.

Abstract

Background: Acute kidney injury (AKI) and chronic kidney disease (CKD) have become worldwide public health problems, but little information is known about the epidemiology of acute kidney disease (AKD)-a state in between AKI and CKD. We aimed to explore the incidence and outcomes of hospitalized patients with AKD after AKI, and investigate the prognostic value of AKD in predicting 30-day and one-year adverse outcomes.

Methods: A total of 2,556 hospitalized AKI patients were identified from three tertiary hospitals in China in 2015 and followed up for one year.AKD and AKD stage were defined according to the consensus report of the Acute Disease Quality Initiative 16 workgroup. Multivariable regression analyses adjusted for confounding variables were used to examine the association of AKD with adverse outcomes.

Results: AKD occurred in 45.4% (1161/2556) of all AKI patients, 14.5% (141/971) of AKI stage 1 patients, 44.6% (308/691) of AKI stage 2 patients and 79.6% (712/894) of AKI stage 3 patients. AKD stage 1 conferred a greater risk of Major Adverse Kidney Events within 30 days (MAKE30) (odds ratio [OR], 2.36; 95% confidence interval 95% CI [1.66-3.36]) than AKD stage 0 but the association only maintained in AKI stage 3 when patients were stratified by AKI stage. However, compared with AKD stage 0, AKD stage 2-3 was associated with higher risks of both MAKE30 and one-year chronic dialysis and mortality independent of the effects of AKI stage with OR being 31.35 (95% CI [23.42-41.98]) and 2.68 (95% CI [2.07-3.48]) respectively. The association between AKD stage and adverse outcomes in 30 days and one year was not significantly changed in critically ill and non-critically ill AKI patients. The results indicated that AKD is common among hospitalized AKI patients. AKD stage 2-3 provides additional information in predicting 30-day and one-year adverse outcomes over AKI stage. Enhanced follow-up of renal function of these patients may be warranted.

Keywords: Acute kidney injury; Kidney disease; Mortality; Outcome; Renal dysfunction.

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81873607, No. 81570618), the Development and Reform Commission of Hunan Province (2014-658), the Scientific Foundation of Hunan Province, China (S2013F1022), and the Clinical Medical Technology Innovation Guide Project of Hunan Province (2017SK50117). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.