Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus |
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Authors: | Thakar Charuhas V Christianson Annette Himmelfarb Jonathan Leonard Anthony C |
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Institution: | Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45220, USA. charuhas.thakar@va.gov |
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Abstract: | SummaryBackground and objectivesPrior studies have examined long-term outcomes of a single acute kidney injury (AKI) event in hospitalized patients. We examined the effects of AKI episodes during multiple hospitalizations on the risk of chronic kidney disease (CKD) in a cohort with diabetes mellitus (DM).Design, setting, participants, & measurementsA total of 4082 diabetics were followed from January 1999 until December 2008. The primary outcome was reaching stage 4 CKD (GFR of <30 ml/min per 1.73 m2). AKI during hospitalization was defined as >0.3 mg/dl or a 1.5-fold increase in creatinine relative to admission. Cox survival models examined the effect of first AKI episode and up to three episodes as time-dependent covariates, on the risk of stage 4 CKD. Covariates included demographic variables, baseline creatinine, and diagnoses of comorbidities including proteinuria.ResultsOf the 3679 patients who met eligibility criteria (mean age = 61.7 years SD, 11.2]; mean baseline creatinine = 1.10 mg/dl SD, 0.3]), 1822 required at least one hospitalization during the time under observation (mean = 61.2 months SD, 25]). Five hundred thirty of 1822 patients experienced one AKI episode; 157 of 530 experienced ≥2 AKI episodes. In multivariable Cox proportional hazards models, any AKI versus no AKI was a risk factor for stage 4 CKD (hazard ratio HR], 3.56; 95% confidence interval CI], 2.76, 4.61); each AKI episode doubled that risk (HR, 2.02; 95% CI, 1.78, 2.30).ConclusionsAKI episodes are associated with a cumulative risk for developing advanced CKD in diabetes mellitus, independent of other major risk factors of progression. |
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