Original Investigation
Pathogenesis and Treatment of Kidney Disease
Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysis

https://doi.org/10.1053/j.ajkd.2008.11.034Get rights and content

Background

Acute kidney injury (AKI) is common in hospitalized patients. The impact of AKI on long-term outcomes is controversial.

Study Design

Systematic review and meta-analysis.

Setting & Participants

Persons with AKI.

Selection Criteria for Studies

MEDLINE and EMBASE databases were searched from 1985 through October 2007. Original studies describing outcomes of AKI for patients who survived hospital discharge were included. Studies were excluded from review when participants were followed up for less than 6 months.

Predictor

AKI, defined as acute changes in serum creatinine level or acute need for renal replacement therapy.

Outcomes

Chronic kidney disease (CKD), cardiovascular disease, and mortality.

Results

48 studies that contained a total of 47,017 participants were reviewed; 15 studies reported long-term data for patients without AKI. The incidence rate of mortality was 8.9 deaths/100 person-years in survivors of AKI and 4.3 deaths/100 patient-years in survivors without AKI (rate ratio [RR], 2.59; 95% confidence interval, 1.97 to 3.42). AKI was associated independently with mortality risk in 6 of 6 studies that performed multivariate adjustment (adjusted RR, 1.6 to 3.9) and with myocardial infarction in 2 of 2 studies (RR, 2.05; 95% confidence interval, 1.61 to 2.61). The incidence rate of CKD after an episode of AKI was 7.8 events/100 patient-years, and the rate of end-stage renal disease was 4.9 events/100 patient-years.

Limitations

The relative risk for CKD and end-stage renal disease after AKI was unattainable because of lack of follow-up of appropriate controls without AKI.

Conclusions

The development of AKI, defined as acute changes in serum creatinine level, characterizes hospitalized patients at increased risk of long-term adverse outcomes.

Section snippets

Methods

This study was performed in accordance with published guidelines for systematic review, analysis, and reporting for meta-analyses of observational studies.21

Results

We identified 3,808 citations meeting our search criteria. After excluding 689 duplicate citations, 3,119 abstracts were evaluated, and 419 articles were selected for further review (Fig 1). Reasons for exclusion are shown in Fig 1. Forty-eight articles were deemed eligible for this systematic review.22, 23, 24, 25, 26, 27, 28, 29, 30, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73

Study and

Discussion

This study shows that patients who survive AKI have a greater rate of long-term mortality and other adverse outcomes than patients who survive hospitalization without AKI. The associations were consistent in every clinical setting. With increasing severity of AKI, the association between AKI and death was even stronger, and the association with long-term mortality seemed to be present even in patients with more rapidly reversible AKI. These findings expand on results from our previous

Acknowledgements

Support: Dr Coca is funded by the career development grant K23DK08013 from the National Institutes of Health and is supported by the American Heart Association's Established Investigator Award. Dr Garg is funded by the Clinical Scientist Award from the Canadian Institutes of Health Research. Dr Parikh is supported by the AKI grants RO1 HL085757 and UO1-DK082185 from the National Institutes of Health.

Financial Disclosure: None.

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    Originally published online as doi:10.1053/j.ajkd.2008.11.034 on April 6, 2009.

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