Acute kidney injury does not worsen kidney function in CKD patients

A study of hospitalized persons with chronic kidney disease (CKD) found that acute kidney injury (AKI) did not predict the worsening of kidney function trajectory once differences in pre-hospitalization characteristically were fully accounted for. Instead, the authors suggest that many of the determinants of faster kidney disease decline observed after AKI may already be present before AKI.

Researchers from the University of California, San Francisco and colleagues in the Chronic Renal Insufficiency Cohort (CRIC study) analyzed data from 3,150 persons with CKD to determine whether AKI is independently associated with subsequent kidney function trajectory. The data showed 612 AKIs in 433 persons with CKD over a median follow-up of 3.9 years.

After adjusting for patient characteristics, such as prehospitalization estimated glomerular filtration rate (eGFR) slope and level of proteinuria, AKI did not predict worsening of subsequent kidney function trajectory. Instead, the authors highlight that their results show that much of the kidney disease observed after AKI may already be present before AKI. They recommend that clinicians instead focus on flattening the eGFR slope and treating proteinuria. The authors do acknowledge that a diagnosis of AKI does present an opportunity to identify high-risk patients and implement evidence-based interventions to slow CKD progression.

Reference: AMERICAN COLLEGE OF PHYSICIANS, JOURNAL Annals of Internal Medicine, DOI 10.7326/M22-3617