INVESTIGATORS in a nationwide study advocate for the use of kidney function assessments before and after dialysis-dependent acute kidney injury (AKI-D), to better predict adverse outcomes in patients. Led by Vin-Cent Wu, National Taiwan University Hospital, Taipei City, Taiwan, the study aimed to explore whether baseline kidney function, acute kidney disease (AKD) severity, and post-AKD kidney function are associated with adverse outcomes in patients with AKI-D.
Overall, of the 6,703 patients in ICU included in the study who had recovered from AKI-D, 28.3% died, 16.7% developed end-stage kidney disease (ESKD), and 11.1% had a major adverse cardiovascular event (MACE). These findings were collected over a mean of 1.2 years of follow-ups. Additionally, nearly half of patients experienced adverse outcomes either during their hospital stay or within 90 days post-discharge, with more than half resuming or continuing dialysis within 90 days.
Specifically, analysis found a significant correlation between kidney function at baseline and 90–135 days post-discharge, with various adverse outcomes including mortality, ESKD, MACE, and hospital readmission. Furthermore, patients whose post-AKD kidney function met criteria for Stage III–V chronic kidney disease (CKD) faced notably increased risks of death (19–58%), MACE (49–99%), and a 19- to 253-fold increased risk of ESKD. Those who already had Stage III–V CKD at baseline before AKI-D also showed increased risks of mortality or MACE compared to patients with a higher baseline estimated glomerular filtration rate. Notably, the risk of ESKD significantly escalated when both baseline and post-AKD kidney function fell into the Stage III–V CKD range.
Based on these findings, the research team suggests that stratifying AKI-D patients based on their post-AKD and baseline kidney function could improve prognostic predictions in clinical practice, emphasising the importance of co-ordinated care to mitigate the transition to chronic kidney disease following AKD.
