title: Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality.
abstract: Existing chronic kidney disease (CKD) is among the most potent predictors of postoperative acute kidney injury (AKI). Here we quantified this risk in a multicenter, observational study of 9425 patients who survived to hospital discharge after major surgery. CKD was defined as a baseline estimated glomerular filtration rate <45 ml/min per 1.73 m(2). AKI was stratified according to the maximum simplified RIFLE classification at hospitalization and unresolved AKI defined as a persistent increase in serum creatinine of more than half above the baseline or the need for dialysis at discharge. A Cox proportional hazard model showed that patients with AKI-on-CKD during hospitalization had significantly worse long-term survival over a median follow-up of 4.8 years (hazard ratio, 1.7) [corrected] than patients with AKI but without CKD.The incidence of long-term dialysis was 22.4 and 0.17 per 100 person-years among patients with and without existing CKD, respectively. The adjusted hazard ratio for long-term dialysis in patients with AKI-on-CKD was 19.8 compared to patients who developed AKI without existing CKD. Furthermore, AKI-on-CKD but without kidney recovery at discharge had a worse outcome (hazard ratios of 4.6 and 213, respectively) for mortality and long-term dialysis as compared to patients without CKD or AKI. Thus, in a large cohort of postoperative patients who developed AKI, those with existing CKD were at higher risk for long-term mortality and dialysis after hospital discharge than those without. These outcomes were significantly worse in those with unresolved AKI at discharge.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Tao-Min
authors.initials: TM
authors.lastname: Huang
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.forename: Chih-Chung
authors.initials: CC
authors.lastname: Shiao
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Wu
authors.forename: Chia-Ter
authors.initials: CT
authors.lastname: Chao
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Tze-Wah
authors.initials: TW
authors.lastname: Kao
authors.forename: Guang-Huar
authors.initials: GH
authors.lastname: Young
authors.forename: Pi-Ru
authors.initials: PR
authors.lastname: Tsai
authors.forename: Hung-Bin
authors.initials: HB
authors.lastname: Tsai
authors.forename: Chieh-Li
authors.initials: CL
authors.lastname: Wang
authors.forename: Ming-Shou
authors.initials: MS
authors.lastname: Wu
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Chiang
authors.forename: I-Jung
authors.initials: IJ
authors.lastname: Tsai
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Shuei-Liong
authors.initials: SL
authors.lastname: Lin
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Chen
authors.forename: Tun-Jun
authors.initials: TJ
authors.lastname: Tsai
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D058186:Acute Kidney Injury; D015331:Cohort Studies; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy; D019370:Observation; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D015996:Survival Rate