title: Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review.
abstract: OBJECTIVE
  To summarise the evidence from studies of acute kidney injury (AKI) with regard to the effect of pre-AKI renal function and post-AKI renal function recovery on long-term mortality and renal outcomes, and to assess whether these factors should be taken into account in future prognostic studies.
  
  
  METHODS
  A systematic review of observational studies listed in Medline and EMBASE from 1990 to October 2012.
  
  
  METHODS
  All AKI studies in adults with data on baseline kidney function to identify AKI; with outcomes either stratified by pre-AKI and/or post-AKI kidney function, or described by the timing of the outcomes.
  
  
  RESULTS
  Long-term mortality and worsening chronic kidney disease (CKD).
  
  
  RESULTS
  Of 7385 citations, few studies met inclusion criteria, reported baseline kidney function and stratified by pre-AKI or post-AKI function. For mortality outcomes, three studies compared patients by pre-AKI renal function and six by post-AKI function. For CKD outcomes, two studies compared patients by pre-AKI function and two by post-AKI function. The presence of CKD pre-AKI (compared with AKI alone) was associated with doubling of mortality and a fourfold to fivefold increase in CKD outcomes. Non-recovery of kidney function was associated with greater mortality and CKD outcomes in some studies, but findings were inconsistent varying with study design. Two studies also reported that risk of poor outcome reduced over time post-AKI. Meta-analysis was precluded by variations in definitions for AKI, CKD and recovery.
  
  
  CONCLUSIONS
  The long-term prognosis after AKI varies depending on cause and clinical setting, but it may also, in part, be explained by underlying pre-AKI and post-AKI renal function rather than the AKI episode itself. While carefully considered in clinical practice, few studies address these factors and with inconsistent study design. Future AKI studies should report pre-AKI and post-AKI function consistently as additional factors that may modify AKI prognosis.
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Renal Unit, Ward 108 Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Sawhney
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Mhairi
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Renal Unit, Ward 108 Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Angharad
authors.initials: A
authors.lastname: Marks
authors.affiliation: Renal Unit, Ward 108 Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Fluck
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Corrinda
authors.initials: C
authors.lastname: Black
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D064887:Observational Studies as Topic; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013995:Time
keywords: EPIDEMIOLOGY; PUBLIC HEALTH