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Acute kidney injury (AKI) and chronic kidney disease (CKD) are more closely intertwined than previously believed, researchers have found.
Each disease is a risk factor for development of the other, and both are risk factors for cardiovascular disease, according to a paper published July 2 in the New England Journal of Medicine.
Paul Kimmel, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases, and colleagues analyzed several large, observational studies and found that the incidence of AKI among hospitalized patients has increased, and that pre-existing CKD increased the odds for AKI by up to 10-fold.
AKI also was associated with a 13-fold increased risk of end-stage renal disease, they found. And patients with AKI and pre-existing CKD had up to a 40-fold increased risk of end-stage renal disease compared with those who had neither.
The authors noted that a prior study found that people with AKI had a higher chance of hospitalization due to heart failure:
- AKI stage 1: HR 1.48, 95% CI 1.16-1.91
- AKI stages 2/3: HR 2.17, 95% CI 1.49-3.15
Another study found that CKD, as measured by glomerular filtration rate, was associated with a 43% increased risk of a cardiovascular event at 45 to 59 mL/min/1.73 m2, and a 315% increased risk at 15 mL/min/1.73 m2.
Other research has found that AKI during a hospital stay may be more deadly than hospitalization for myocardial infarction.
Kimmel told MedPage Today that there needs to be a change in the way AKI and CKD are viewed as separate diseases. In addition, nephrologists, primary care doctors, and surgeons need to institute methods so that patients with AKI are followed by somebody specifically interested in renal function, he said.
And, he added, more clinical trials need to be done to see how to best treat people with AKI. "This paper is a clarion call for better research for patients," Kimmel said. "Doctors have to follow the patients and we have to develop better treatment strategies for the patient."
EndoType is a blog for readers with an interest in endocrinology.
Disclosures
Co-author Lakhmir S. Chawla, MD, disclosed relevant relationships with AbbVie, AM-Pharma, Alere, Covidien, Gambro, Bard Medical, NxStage Medical, Astute Medical, Ikaria, and Eli Lilly.