title: Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data.
abstract: BACKGROUND
  Studies suggest an association between acute kidney injury (AKI) and long-term risk for chronic kidney disease (CKD), even following apparent renal recovery. Whether the pattern of renal recovery predicts kidney risk following AKI is unknown.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Patients in the Veterans Health Administration in 2011 hospitalized (> 24 hours) with at least 2 inpatient serum creatinine measurements, baseline estimated glomerular filtration rate > 60 mL/min/1.73 m², and no diagnosis of end-stage renal disease or non-dialysis-dependent CKD: 17,049 (16.3%) with and 87,715 without AKI.
  
  
  METHODS
  Pattern of recovery to creatinine level within 0.3 mg/dL of baseline after AKI: within 2 days (fast), in 3 to 10 days (intermediate), and no recovery by 10 days (slow or unknown).
  
  
  RESULTS
  CKD stage 3 or higher, defined as 2 outpatient estimated glomerular filtration rates < 60 mL/min/1.73m² at least 90 days apart or CKD diagnosis, dialysis therapy, or transplantation.
  
  
  METHODS
  Risk for CKD was modeled using modified Poisson regression and time to death-censored CKD was modeled using Cox proportional hazards regression, both stratified by AKI stage.
  
  
  RESULTS
  Most patients' AKI episodes were stage 1 (91%) and 71% recovered within 2 days. At 1 year, 18.2% had developed CKD (AKI, 31.8%; non-AKI, 15.5%; P < 0.001). In stage 1, the adjusted relative risk ratios for CKD stage 3 or higher were 1.43 (95% CI, 1.39-1.48), 2.00 (95% CI, 1.88-2.12), and 2.65 (95% CI, 2.51-2.80) for fast, intermediate, and slow/unknown recovery. A similar pattern was observed in subgroup analyses incorporating albuminuria and sensitivity analysis of death-censored time to CKD.
  
  
  CONCLUSIONS
  Variable timing of follow-up and mostly male veteran cohort may limit generalizability.
  
  
  CONCLUSIONS
  Patients who develop AKI during a hospitalization are at substantial risk for the development of CKD by 1 year following hospitalization and timing of AKI recovery is a strong predictor, even for the mildest forms of AKI.
authors.affiliation: Kidney Epidemiology and Cost Center, Ann Arbor, MI. Electronic address: mheung@umich.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
authors.affiliation: Kidney Epidemiology and Cost Center, Ann Arbor, MI.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Steffick
authors.affiliation: Department of Psychology, University of Michigan, Ann Arbor, MI; Ann Arbor Veteran Affairs Medical Center, Ann Arbor, MI.
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.affiliation: Kidney Epidemiology and Cost Center, Ann Arbor, MI.
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Tanushree
authors.initials: T
authors.lastname: Banerjee
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.affiliation: Centers for Disease Control, Atlanta, GA.
authors.forename: Meda E
authors.initials: ME
authors.lastname: Pavkov
authors.affiliation: Centers for Disease Control, Atlanta, GA.
authors.forename: Desmond E
authors.initials: DE
authors.lastname: Williams
authors.affiliation: Kidney Epidemiology and Cost Center, Ann Arbor, MI.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.affiliation: Kidney Epidemiology and Cost Center, Ann Arbor, MI.
authors.forename: Vahakn B
authors.initials: VB
authors.lastname: Shahinian
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D016030:Kidney Transplantation; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D020127:Recovery of Function; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: AKI outcomes; Renal recovery; Veterans Administration (VA); acute kidney injury (AKI); acute on chronic kidney disease; chronic kidney disease (CKD); kidney function; recovery speed; renal complications; serum creatinine