title: Risk of chronic dialysis and death following acute kidney injury.
abstract: BACKGROUND
  Acute kidney injury frequently arises within an acute care hospitalization. Outcomes among acute kidney injury survivors following hospital discharge are poorly documented.
  
  
  METHODS
  We conducted a population-based cohort study between 1996 and 2006 of all adult patients in Ontario with acute kidney injury who did not require in-hospital dialysis, and who survived free of dialysis ≥30 days after discharge. Those with acute kidney injury (n=41,327) were matched 1:1 to patients without acute kidney injury during their index hospitalization. Matching was by age (±1 year), sex, history of chronic kidney disease, receipt of mechanical ventilation during the index hospitalization, and a propensity score for developing acute kidney injury. The primary outcome was subsequent need for chronic dialysis. The secondary outcomes were all-cause mortality and rehospitalization.
  
  
  RESULTS
  Mean age was 70 years, and median follow-up was 2 years (maximum 10 years). The incidence of chronic dialysis was 1.78 per 100 person-years among those with acute kidney injury and 0.74 per 100 person-years among unaffected controls (adjusted hazard ratio [HR]; 2.70, 95% confidence interval [CI], 2.42-3.00). Rates also were higher for all-cause mortality (15.34 vs 14.51 per-100 person-years; adjusted HR 1.10; 95% CI, 1.07-1.13) and rehospitalization (44.93 vs 37.18 per 100 person-years; adjusted HR 1.21; 95% CI, 1.18-1.24).
  
  
  CONCLUSIONS
  Even when acute dialysis is not required, survivors of acute kidney injury remain at higher risk of receipt of chronic dialysis thereafter. The absolute risk of death was more than 8 times the rate of chronic dialysis.
authors.affiliation: Division of Nephrology, St. Michael's Hospital and University of Toronto, Ontario, Canada. waldr@smh.ca
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
authors.forename: Neill K
authors.initials: NK
authors.lastname: Adhikari
authors.forename: Karen E
authors.initials: KE
authors.lastname: Burns
authors.forename: Jan O
authors.initials: JO
authors.lastname: Friedrich
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Ziv
authors.initials: Z
authors.lastname: Harel
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Hladunewich
authors.forename: Jin
authors.initials: J
authors.lastname: Luo
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
authors.forename: Joel G
authors.initials: JG
authors.lastname: Ray
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D006435:Renal Dialysis / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors