Document Detail


The severity of acute kidney injury predicts progression to chronic kidney disease.
MedLine Citation:
PMID:  21430640     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Acute kidney injury (AKI) is associated with progression to advanced chronic kidney disease (CKD). We tested whether patients who survive AKI and are at higher risk for CKD progression can be identified during their hospital admission, thus providing opportunities to intervene. This was assessed in patients in the Department of Veterans Affairs Healthcare System hospitalized with a primary diagnosis indicating AKI (ICD9 codes 584.xx). In the exploratory phase, three multivariate prediction models for progression to stage 4 CKD were developed. In the confirmatory phase, the models were validated in 11,589 patients admitted for myocardial infarction or pneumonia during the same time frame that had RIFLE codes R, I, or F and complete data for all predictor variables. Of the 5351 patients in the AKI group, 728 entered stage 4 CKD after hospitalization. Models 1, 2, and 3 were all significant with 'c' statistics of 0.82, 0.81, and 0.77, respectively. In model validation, all three were highly significant when tested in the confirmatory patients, with moderate to large effect sizes and good predictive accuracy ('c' 0.81-0.82). Patients with AKI who required dialysis and then recovered were at especially high risk for progression to CKD. Hence, the severity of AKI is a robust predictor of progression to CKD.
Authors:
Lakhmir S Chawla; Richard L Amdur; Susan Amodeo; Paul L Kimmel; Carlos E Palant
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Validation Studies     Date:  2011-03-23
Journal Detail:
Title:  Kidney international     Volume:  79     ISSN:  1523-1755     ISO Abbreviation:  Kidney Int.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-31     Completed Date:  2011-09-16     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1361-9     Citation Subset:  IM    
Affiliation:
Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, District of Columbia, USA. lchawla@mfa.gwu.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / complications*,  diagnosis,  therapy
Chi-Square Distribution
Disease Progression
Female
Health Status Indicators*
Hospitalization
Humans
Kidney Failure, Chronic / diagnosis,  etiology*,  prevention & control
Logistic Models
Male
Odds Ratio
Patient Discharge
Predictive Value of Tests
Prognosis
Renal Dialysis
Reproducibility of Results
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
United States
United States Department of Veterans Affairs
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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