Outcomes associated with acute kidney disease: A systematic review and meta-analysis

Ching-Chun Su; Jui-Yi Chen; Sheng-Yin Chen; Chih-Chung Shiao; Javier A Neyra; Ryo Matsuura; Eisei Noiri; Emily See; Yih-Ting Chen; Cheng-Kai Hsu; Heng-Chih Pan; Chih-Hsiang Chang; Mitchell H Rosner; Vin-Cent Wu

doi:10.1016/j.eclinm.2022.101760

Outcomes associated with acute kidney disease: A systematic review and meta-analysis

EClinicalMedicine. 2022 Dec 13:55:101760. doi: 10.1016/j.eclinm.2022.101760. eCollection 2023 Jan.

Authors

Ching-Chun Su¹, Jui-Yi Chen^{1

2}, Sheng-Yin Chen³, Chih-Chung Shiao⁴, Javier A Neyra⁵, Ryo Matsuura⁶, Eisei Noiri⁷, Emily See^{8

9}, Yih-Ting Chen¹⁰, Cheng-Kai Hsu¹⁰, Heng-Chih Pan¹⁰, Chih-Hsiang Chang¹¹, Mitchell H Rosner¹², Vin-Cent Wu¹³

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
² Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
³ Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong; and Saint Mary's Junior College of Medicine, Nursing and Management, Yilan, Taiwan.
⁵ Department of Internal Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁶ Department of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
⁷ National Center Biobank Network, National Center for Global Health and Medicine, Shinjuku, Japan.
⁸ Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia.
⁹ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia.
¹⁰ Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Taiwan.
¹¹ Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan City, Taiwan.
¹² Department of Medicine, University of Virginia Health System Charlottesville, VA, 22908, USA.
¹³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

Background: Acute kidney disease (AKD) defines the period after kidney damage and it is a critical period of both repair and fibrotic pathways. However, the outcomes of patients with AKD have not been well-defined.

Methods: In this meta-analysis, PubMed, Embase, Cochrane and China National Knowledge Infrastructure were searched on July 31,2022. We excluded studies including patients undergoing kidney replacement therapy at enrollment. The data was used to conduct a random-effects model for pool outcomes between patients with AKD and non-AKD (NKD). This study is registered with PROSPERO, CRD 42021271773.

Findings: The search generated 739 studies of which 21 studies were included involving 1,114,012 patients. The incidence rate of community-acquired AKD was 4.60%, 2.11% in hospital-acquired AKD without a prior AKI episode, and 26.11% in hospital-acquired AKD with a prior AKI episode. The all-cause mortality rate was higher in the AKD group (26.54%) than in the NKD group (7.78%) (odds ratio [OR]: 3.62, 95% confidence interval [CI]: 2.64 to 4.95, p < 0.001, I² = 99.11%). The rate of progression to end-stage kidney disease (ESKD) was higher in the AKD group (1.3%) than in the NKD group (0.14%) (OR: 6.58, p < 0.001, I² = 94.95%). The incident rate of CKD and progressive CKD was higher in the AKD group (37.2%) than in the NKD group (7.45%) (OR:4.22, p < 0.001, I² = 96.67%). Compared to the NKD group, patients with AKD without prior AKI had a higher mortality rate (OR: 3.00, p < 0.001, I² = 99.31%) and new-onset ESKD (OR:4.96, 95% CI, p = 0.002, I² = 97.37%).

Interpretation: AKD is common in community and hospitalized patients who suffer from AKI and also occurs in patients without prior AKI. The patients with AKD, also in those without prior AKI had a higher risk of mortality, and new-onset ESKD than the NKD group.

Funding: This study was supported by Ministry of Science and Technology (MOST) of the Republic of China (Taiwan) [grant number, MOST 107-2314-B-002-026-MY3, 108-2314-B-002-058, 110-2314-B-002-241, 110-2314-B-002-239], National Science and Technology Council (NSTC) [grant number, NSTC 109-2314-B-002-174-MY3, 110-2314-B-002-124-MY3, 111-2314-B-002-046, 111-2314-B-002-058], National Health Research Institutes [PH-102-SP-09], National Taiwan University Hospital [109-S4634, PC-1246, PC-1309, VN109-09, UN109-041, UN110-030, 111-FTN0011] Grant MOHW110-TDU-B-212-124005, Mrs. Hsiu-Chin Lee Kidney Research Fund and Chi-mei medical center CMFHR11136. JAN is supported, in part, by grants from the National Institute of Health, NIDDK (R01 DK128208 and P30 DK079337) and NHLBI (R01 HL148448-01).

Keywords: Acute kidney disease; Acute kidney injury; Chronic kidney disease; End-stage kidney disease.

Abstract

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