Stress-Related Disorder Increases the risk of AKI and Progression of CKD

Previous studies suggest that exposure to SRDs has been associated with the subsequent risk of cardiovascular disease (CVD), autoimmune diseases (such as antineutrophil cytoplasmic antibodies (ANCA) vasculitis and systematic lupus erythematosus) and infections. Both CVD and autoimmune diseases are also established risk factors for kidney function decline. Dr Guobin Su, MD, PhD and team hypothesized that SDRs may primarily increase the risk of chronic kidney disease (CKD) progression. They conducted a secondary analysis, to explore the association between stress-related disorders and acute kidney injury (AKI).

The study was based on the Stockholm CREAtinine Measurements [SCREAM] project, a population-matched cohort study in Sweden that included 30,998 patients receiving an SRDs diagnosis and 116,677 unexposed patients matched by age, sex and estimated glomerular filtration rates (eGFR). The major outcome assessed was CKD progression. They also assessed for incidence of AKI as a secondary outcome. They used Cox models for statistical analysis.

Key findings of the study were:

• During a medium follow-up of 3.2 years, they found, compared to the unexposed, patients with SRDs were at increased risk of CKD progression (HR 1.23) and AKI (HR 1.22).

• They noted that the AKI risk was highest during the first year of follow up, but CKD risk persisted throughout the entire follow-up period.

• They also noted that the results were consistent in stratified analyses, when only considering AKI-hospitalizations/death and when disregarding eGFR measurements close to the index date.

The authors concluded, "A diagnosis of SRDs is associated with subsequent risk of AKI and CKD progression. While studies should confirm this observation and characterize underlying mechanisms, close monitoring of kidney function following SRDs diagnosis may be indicated."

For further information:

https://www.kireports.org/article/S2468-0249(20)31866-0/fulltext