Original Investigation
Nephrology
March 8, 2024
Recovery Dynamics and Prognosis After Dialysis for Acute Kidney Injury
Heng-Chih Pan, Hsing-Yu Chen, Nai-Chi Teng, et al
JAMA Netw Open. 2024;7(3):e240351. doi:10.1001/jamanetworkopen.2024.0351
Question Are baseline kidney function, acute kidney disease (AKD) severity, and post-AKD kidney function associated with adverse outcomes in patients with acute kidney injury requiring dialysis (AKI-D)?
Findings In this cohort study with 6703 participants, baseline kidney function and post-AKD kidney function were significant independent factors associated with all-cause mortality, major adverse cardiac events, end-stage kidney disease, and readmission in patients with AKI-D. Worse post-AKD kidney function was associated with a progressive increase in the risk of adverse outcomes; however, AKD severity was not associated with adverse outcomes.
Meaning These findings suggest that evaluating baseline and post-AKD kidney function is crucial for understanding the risk of adverse outcomes in patients with AKI-D.
Abstract
Importance The interplay among baseline kidney function, severity of acute kidney disease (AKD), and post-AKD kidney function has significant associations with patient outcomes. However, a comprehensive understanding of how these factors are collectively associated with mortality, major adverse cardiac events (MACEs), and end-stage kidney disease (ESKD) in patients with dialysis-requiring acute kidney injury (AKI-D) is yet to be fully explored.
Objective To investigate the associations of baseline kidney function, AKD severity, and post-AKD kidney function with mortality, MACEs, and ESKD in patients with AKI-D.
Design, Setting, and Participants This nationwide, population-based cohort study of patients with AKI-D was conducted between January 1, 2015, and December 31, 2018, using data from various health care settings included in the Chinese Taipei statewide population-based cohort database. Data analysis was conducted from April 28, 2022, to June 30, 2023.
Exposure Exposure to severe AKI and baseline and post-AKD kidney function.
Main Outcomes and Measures The primary outcomes were all-cause mortality and incident MACEs, and secondary outcomes were risks of permanent dialysis and readmission.
Results A total of 6703 of 22 232 patients (mean [SD] age, 68.0 [14.7] years; 3846 [57.4%] male) with AKI-D with post-AKD kidney function follow-up and AKD stage data were enrolled. During a mean (SD) 1.2 (0.9) years of follow-up, the all-cause mortality rate was 28.3% (n = 1899), while the incidence rates of MACEs and ESKD were 11.1% (n = 746) and 16.7% (n = 1119), respectively. After adjusting for known covariates, both post-AKD kidney function and baseline kidney function, but not AKD severity, were independently associated with all-cause mortality, MACEs, ESKD, and readmission. Moreover, worse post-AKD kidney function correlated with progressive and significant increases in the risk of adverse outcomes.
Conclusions and Relevance In this cohort study of patients with AKI-D, more than one-quarter of patients died after 1.2 years of follow-up. Baseline and post-AKD kidney functions serve as important factors associated with the long-term prognosis of patients with AKI-D. Therefore, concerted efforts to understand the transition from post-AKD to chronic kidney disease are crucial.
