title: Long-term outcome of severe acute kidney injury survivors followed by nephrologists in a developing country.
abstract: OBJECTIVE
  This study aimed to evaluate the long-term outcome of patients after a severe episode of acute kidney injury (AKI) on survival and progression to chronic kidney disease (CKD) and to identify risk factors associated with these outcomes.
  
  
  METHODS
  We performed a prospective study that evaluated the long-term outcome of 509 AKI stage 3 patients who were followed by nephrologists in a Brazilian University Hospital from 2004 to 2013.
  
  
  RESULTS
  Age was 60.2 years (47.5-71) and the follow-up time was 25 months (12-44). The late mortality was 38.1% and age (HR 2.89, 95% CI=1.88 to 4.46, P < 0.0001), diabetes (HR 1.46, 95% CI=1 0.02 to 2.16, P < 0.047), liver disease (HR 2.95, 95% CI=1.19 to 7.3, P = 0.02) and creatinine (Cr) at the time of hospital discharge (HR 1.21, 95% CI=1.04 to 1.41, P = 0.01) were associated with poor long-term survival. At the moment of hospital discharge, 52.1% of patients had complete recovery of renal function, 39.7% had partial recovery and 8.3% had not recovered renal function. After 36 months, 43.5% of patients progressed to CKD, and 5.3% needed for chronic dialysis. Factors associated with progression to CKD were age (HR 1.02, 95% CI=1.008 to 1.035, P = 0.009), CKD (HR 1.05 95% CI=1.007 to 1.09, P = 0.04), diabetes (HR 1.12, CI 1.008-1.035, P = 0.009) and number of AKI episodes (HR 1.65, 95% CI=1.19 to 2.2, P = 0.0023).
  
  
  CONCLUSIONS
  This study showed that AKI patients have high mortality after hospital discharge and age, diabetes, liver disease, and Cr value at the time of discharge were factors associated with long-term mortality. The risk factors for this progression to CKD were age, the presence of diabetes and the number of AKI episodes.
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: Dayana Bitencourt
authors.initials: DB
authors.lastname: Dias
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: Ginivaldo Ribeiro
authors.initials: GR
authors.lastname: Nascimento
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: Liciana Vaz de Arruda
authors.initials: LV
authors.lastname: Silveira
authors.affiliation: University São Paulo State-UNESP, Distrito de Rubiao Junior, Botucatu, Sao Paulo, Brazil.
authors.forename: André Luís
authors.initials: AL
authors.lastname: Balbi
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D003404:Creatinine / Q000097:blood; D003906:Developing Countries; D048909:Diabetes Complications / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000072104:Nephrologists; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: acute kidney injury; long-term; progression to chronic kidney disease; survival