New insights into acute-on-chronic kidney disease in nephrology patients: the CKD-REIN study.
acute kidney injury
acute-on-chronic kidney disease
chronic kidney disease
kidney failure
renal recovery
Journal
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
ISSN: 1460-2385
Titre abrégé: Nephrol Dial Transplant
Pays: England
ID NLM: 8706402
Informations de publication
Date de publication:
22 08 2022
22 08 2022
Historique:
received:
17
03
2021
pubmed:
3
9
2021
medline:
25
8
2022
entrez:
2
9
2021
Statut:
ppublish
Résumé
Acute-on-chronic kidney disease (ACKD) is poorly understood and often overlooked. We studied its incidence, circumstances, determinants and outcomes in patients with CKD. We used the Kidney Disease: Improving Global Outcomes criteria to identify all-stage acute kidney injury (AKI) events in 3033 nephrology outpatients with CKD Stages 3-5 participating in the CKD-Renal Epidemiology and Information Network cohort study (2013-20), and cause-specific Cox models to estimate hazard ratios [HRs; 95% confidence intervals (CIs)] of AKI-associated risk factors. At baseline, 22% of the patients [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] had a history of AKI. Over a 3-year follow-up, 443 had at least one AKI event: 27% were Stage 2 or 3 and 11% required dialysis; 74% involved hospitalization including 47% acquired as hospital inpatients; and a third were not reported in hospital discharge reports. Incidence rates were 10.1 and 4.8/100 person-years in patients with and without an AKI history, respectively. In 2375 patients without this history, male sex, diabetes, cardiovascular disease, cirrhosis, several drugs, low eGFR and serum albumin levels were significantly associated with a higher risk of AKI, as were low birth weight (<2500 g) (adjusted HR 1.98; 95% CI 1.35-2.91) and haemoglobin level (HR 1.21; 1.12-1.32 per 1 g/dL decrease). Within 1 year, only 63% of the patients had recovered their previous kidney function, 13.7% had started kidney replacement therapy and 12.7% had died. The study highlights the high rate of hospital-acquired AKI events in patients with CKD, and their underreporting at hospital discharge. It also reveals low birth weight and anaemia as possible new risk factors in CKD patients.
Sections du résumé
BACKGROUND
Acute-on-chronic kidney disease (ACKD) is poorly understood and often overlooked. We studied its incidence, circumstances, determinants and outcomes in patients with CKD.
METHODS
We used the Kidney Disease: Improving Global Outcomes criteria to identify all-stage acute kidney injury (AKI) events in 3033 nephrology outpatients with CKD Stages 3-5 participating in the CKD-Renal Epidemiology and Information Network cohort study (2013-20), and cause-specific Cox models to estimate hazard ratios [HRs; 95% confidence intervals (CIs)] of AKI-associated risk factors.
RESULTS
At baseline, 22% of the patients [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] had a history of AKI. Over a 3-year follow-up, 443 had at least one AKI event: 27% were Stage 2 or 3 and 11% required dialysis; 74% involved hospitalization including 47% acquired as hospital inpatients; and a third were not reported in hospital discharge reports. Incidence rates were 10.1 and 4.8/100 person-years in patients with and without an AKI history, respectively. In 2375 patients without this history, male sex, diabetes, cardiovascular disease, cirrhosis, several drugs, low eGFR and serum albumin levels were significantly associated with a higher risk of AKI, as were low birth weight (<2500 g) (adjusted HR 1.98; 95% CI 1.35-2.91) and haemoglobin level (HR 1.21; 1.12-1.32 per 1 g/dL decrease). Within 1 year, only 63% of the patients had recovered their previous kidney function, 13.7% had started kidney replacement therapy and 12.7% had died.
CONCLUSIONS
The study highlights the high rate of hospital-acquired AKI events in patients with CKD, and their underreporting at hospital discharge. It also reveals low birth weight and anaemia as possible new risk factors in CKD patients.
Identifiants
pubmed: 34473306
pii: 6362900
doi: 10.1093/ndt/gfab249
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1700-1709Investigateurs
Carole Ayav
(C)
Serge Briançon
(S)
Dorothée Cannet
(D)
Christian Combe
(C)
Denis Fouque
(D)
Luc Frimat
(L)
Yves-Edouard Herpe
(YE)
Christian Jacquelinet
(C)
Maurice Laville
(M)
Ziad A Massy
(ZA)
Christophe Pascal
(C)
Bruce M Robinson
(BM)
Bénédicte Stengel
(B)
Céline Lange
(C)
Karine Legrand
(K)
Sophie Liabeuf
(S)
Marie Metzger
(M)
Elodie Speyer
(E)
Prs Thierry Hannedouche
(PT)
Bruno Moulin
(B)
Sébastien Mailliez
(S)
Gaétan Lebrun
(G)
Eric Magnant
(E)
Gabriel Choukroun
(G)
Benjamin Deroure
(B)
Adeline Lacraz
(A)
Guy Lambrey
(G)
Jean Philippe Bourdenx
(JP)
Marie Essig
(M)
Thierry Lobbedez
(T)
Raymond Azar
(R)
Hacène Sekhri
(H)
Mustafa Smati
(M)
Mohamed Jamali
(M)
Alexandre Klein
(A)
Michel Delahousse
(M)
Christian Combe
(C)
Séverine Martin
(S)
Isabelle Landru
(I)
Eric Thervet
(E)
Philippe Lang
(P)
Xavier Belenfant
(X)
Pablo Urena
(P)
Carlos Vela
(C)
Nassim Kamar
(N)
Dominique Chauveau
(D)
Viktor Panescu
(V)
Christian Noel
(C)
François Glowacki
(F)
Maxime Hoffmann
(M)
Maryvonne Hourmant
(M)
Dominique Besnier
(D)
Angelo Testa
(A)
François Kuentz
(F)
Philippe Zaoui
(P)
Charles Chazot
(C)
Laurent Juillard
(L)
Stéphane Burtey
(S)
Adrien Keller
(A)
Nathalie Maisonneuve
(N)
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of ERA. All rights reserved.