Nonrecovery of kidney function and death after acute on chronic renal failure.
OBJECTIVE
Relatively little is known about clinical outcomes, especially long-term outcomes, among patients who have chronic kidney disease (CKD) and experience superimposed acute renal failure (ARF; acute on chronic renal failure).


METHODS
We tracked 39,805 members of an integrated health care delivery system in northern California who were hospitalized during 1996 through 2003 and had prehospitalization estimated GFR (eGFR) <45 ml/min per 1.73 m(2). Superimposed ARF was defined as having both a peak inpatient serum creatinine greater than the last outpatient serum creatinine by > or =50% and receipt of acute dialysis.


RESULTS
Overall, 26% of CKD patients who suffered superimposed ARF died during the index hospitalization. There was a high risk for developing ESRD within 30 d of hospital discharge that varied with preadmission renal function, being 42% among hospital survivors with baseline eGFR 30-44 ml/min per 1.73 m(2) and 63% among hospital survivors with baseline eGFR 15-29 ml/min per 1.73 m(2). Compared with patients who had CKD and did not experience superimposed ARF, those who did had a 30% higher long-term risk for death or ESRD.


CONCLUSIONS
In a large, community-based cohort of patients with CKD, an episode of superimposed dialysis-requiring ARF was associated with very high risk for nonrecovery of renal function. Dialysis-requiring ARF also seemed to be an independent risk factor for long-term risk for death or ESRD.
Hsu
Chi-yuan
CY
Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0532, USA. hsuchi@medicine.ucsf.edu
Chertow
Glenn M
GM
McCulloch
Charles E
CE
Fan
Dongjie
D
Ordoñez
Juan D
JD
Go
Alan S
AS
D058186:Acute Kidney Injury / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors
D003404:Creatinine