title: Chronic kidney disease progression is mainly associated with non-recovery of acute kidney injury.
abstract: BACKGROUND
  Identifying individuals who are at increased risk for accelerated progressive chronic kidney disease (CKD) and who might benefit from preventive interventions is an important challenge.
  
  
  METHODS
  The present observational study evaluated the effect of an episode of Acute Kidney Injury (AKI) on the evolution of the renal trajectory in a cohort of 311 ambulatory CKD patients. We analyzed the evolution of eGFR in this cohort within a 5-year time window around an AKI episode. The mean of the available eGFR-values over a 6 month period was calculated once at the start and once at the end of the 5-year period. Slow and fast CKD progression were defined as a decrease by respectively ≤ or >1 category of 15 ml/min/1.73 m(2) over the 5-year time window. The influence of AKI on progression status was analyzed.
  
  
  RESULTS
  Median eGFR decline over the 5 year period was 11, 22 and 6 ml/min/1.73 m(2) in the total, AKI and no AKI group respectively. AKI occurred in 44/72 versus 50/239 of fast versus slow progressors (odds ratio: 5.9, 95% confidence interval: 3.4-10.5). An incomplete recovery of eGFR after an AKI episode (median in overall, fast progressors, slow progressors 11, 20 and 4 ml/min/1.73 m(2) respectively) was the major component for the overall loss of renal function over the 5-year window. Our data failed to provide evidence that the CKD progression became more accelerated once kidney function was stabilized after the AKI episode.
  
  
  CONCLUSIONS
  Incomplete recovery of AKI was related with accelerated CKD-progression. Episodes of AKI were not associated with an accelerated decline of kidney function once the AKI episode had resolved. In the group without AKI episode, the progression was similar to that of the general population without CKD.
authors.affiliation: Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium. eric.dhoore@ugent.be.
authors.forename: Eric
authors.initials: E
authors.lastname: D'hoore
authors.affiliation: Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Neirynck
authors.affiliation: Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium.
authors.forename: Eva
authors.initials: E
authors.lastname: Schepers
authors.affiliation: Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium.
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.affiliation: Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium.
authors.forename: Francis
authors.initials: F
authors.lastname: Verbeke
authors.affiliation: Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium.
authors.forename: Mira
authors.initials: M
authors.lastname: Van Thielen
authors.affiliation: Nephrology Division, Department of Internal Medicine, Ghent University Hospital, 0K12IA, De Pintelaan 185, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors
keywords: Acute kidney injury (AKI); Cohort study; Epidemiology; Evolution renal function; Renal function trajectory