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Chronic kidney disease progression is mainly associated with non-recovery of acute kidney injury

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Abstract

Background

Identifying individuals who are at increased risk for accelerated progressive chronic kidney disease (CKD) and who might benefit from preventive interventions is an important challenge.

Methods

The present observational study evaluated the effect of an episode of Acute Kidney Injury (AKI) on the evolution of the renal trajectory in a cohort of 311 ambulatory CKD patients. We analyzed the evolution of eGFR in this cohort within a 5-year time window around an AKI episode. The mean of the available eGFR-values over a 6 month period was calculated once at the start and once at the end of the 5-year period. Slow and fast CKD progression were defined as a decrease by respectively ≤ or >1 category of 15 ml/min/1.73 m2 over the 5-year time window. The influence of AKI on progression status was analyzed.

Results

Median eGFR decline over the 5 year period was 11, 22 and 6 ml/min/1.73 m2 in the total, AKI and no AKI group respectively. AKI occurred in 44/72 versus 50/239 of fast versus slow progressors (odds ratio: 5.9, 95 % confidence interval: 3.4–10.5). An incomplete recovery of eGFR after an AKI episode (median in overall, fast progressors, slow progressors 11, 20 and 4 ml/min/1.73 m2 respectively) was the major component for the overall loss of renal function over the 5-year window. Our data failed to provide evidence that the CKD progression became more accelerated once kidney function was stabilized after the AKI episode.

Conclusions

Incomplete recovery of AKI was related with accelerated CKD-progression. Episodes of AKI were not associated with an accelerated decline of kidney function once the AKI episode had resolved. In the group without AKI episode, the progression was similar to that of the general population without CKD.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

Collection of samples and patient medical data was approved by the ethical committee of the Ghent University Hospital.

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Authors and Affiliations

  1. Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium

    Eric D’hoore, Nathalie Neirynck, Eva Schepers, Raymond Vanholder, Francis Verbeke, Mira Van Thielen & Wim Van Biesen

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  1. Eric D’hoore
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  2. Nathalie Neirynck
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  3. Eva Schepers
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  4. Raymond Vanholder
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Correspondence to Eric D’hoore.

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D’hoore, E., Neirynck, N., Schepers, E. et al. Chronic kidney disease progression is mainly associated with non-recovery of acute kidney injury. J Nephrol 28, 709–716 (2015). https://doi.org/10.1007/s40620-015-0181-5

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  • DOI: https://doi.org/10.1007/s40620-015-0181-5

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