AKI and Long-Term Risk for Cardiovascular Events and Mortality.
AKI associates with increased long-term risk of mortality, but the prognostic significance of AKI in terms of long-term cardiovascular disease remains unconfirmed. We conducted a systematic review and meta-analysis to assess whether AKI associates with long-term cardiovascular disease. We included cohort studies that examined adults with and without AKI and reported a multivariable-adjusted relative risk (RR) for the association between AKI and cardiovascular mortality, major cardiovascular events, and disease-specific events: congestive heart failure, acute myocardial infarction, and stroke. Twenty-five studies involving 254,408 adults (55,150 with AKI) were included. AKI associated with an 86% and a 38% increased risk of cardiovascular mortality and major cardiovascular events, respectively ([RR 1.86; 95% confidence interval (95% CI), 1.72 to 2.01] and [RR 1.38; 95% CI, 1.23 to 1.55], respectively). For disease-specific events, AKI associated with a 58% increased risk of heart failure (RR 1.58; 95% CI, 1.46 to 1.72) and a 40% increased risk of acute myocardial infarction (RR 1.40; 95% CI, 1.23 to 1.59). The elevated risk of heart failure and acute myocardial infarction persisted in subgroup analyses on the basis of AKI severity and the proportion of adults with baseline ischemic heart disease. Finally, AKI was associated with a 15% increased risk of stroke (RR 1.15; 95% CI, 1.03 to 1.28). In conclusion, AKI associates with an elevated risk of cardiovascular mortality and major cardiovascular events, particularly heart failure and acute myocardial infarction.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ayodele.odutayo@mail.utoronto.ca.|Centre for Statistics in Medicine.
Ayodele
A
Odutayo
Nuffield Department of Population Health.
Christopher X
CX
Wong
Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada; and.
Michael
M
Farkouh
Centre for Statistics in Medicine.
Douglas G
DG
Altman
Centre for Statistics in Medicine.
Sally
S
Hopewell
St. John's College, and.
Connor A
CA
Emdin
School of Medicine, University of Tasmania, Hobart, Australia.|Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
Benjamin H
BH
Hunn
D058186:Acute Kidney Injury / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D012307:Risk Factors; D013997:Time Factors
Ischemic Heart Disease; Stroke; acute renal failure; cardiovascular disease; congestive heart failure