title: Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease.
abstract: To determine whether acute renal failure (ARF) increases the long-term risk of progressive chronic kidney disease (CKD), we studied the outcome of patients whose initial kidney function was normal or near normal but who had an episode of dialysis-requiring ARF and did not develop end-stage renal disease within 30 days following hospital discharge. The study encompassed 556,090 adult members of Kaiser Permanente of Northern California hospitalized over an 8 year period, who had pre-admission estimated glomerular filtration rates (eGFR) equivalent to or greater than 45 ml/min/1.73 m(2) and who survived hospitalization. After controlling for potential confounders such as baseline level of eGFR and diabetes status, dialysis-requiring ARF was independently associated with a 28-fold increase in the risk of developing stage 4 or 5 CKD and more than a twofold increased risk of death. Our study shows that in a large, community-based cohort of patients with pre-existing normal or near normal kidney function, an episode of dialysis-requiring ARF was a strong independent risk factor for a long-term risk of progressive CKD and mortality.
authors.affiliation: Department of Medicine, University of California, San Francisco, 94143-0532, USA.
authors.forename: Lowell J
authors.initials: LJ
authors.lastname: Lo
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.forename: Dongjie
authors.initials: D
authors.lastname: Fan
authors.forename: Juan D
authors.initials: JD
authors.lastname: Ordoñez
authors.forename: Chi-yuan
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D002140:California / Q000453:epidemiology; D019992:Databases as Topic; D003956:Dialysis; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors