title: The risk of chronic kidney disease and mortality are increased after community-acquired acute kidney injury.
abstract: We investigated whether community-acquired acute kidney injury encountered in a tertiary hospital emergency department setting increases the risk of chronic kidney disease (CKD) and mortality, and whether plasma biomarkers could improve the prediction of those adverse outcomes. In a prospective cohort study, we enrolled 616 patients at admission to the emergency department and followed them for a median of 62.1 months. Within this cohort, 130 patients were adjudicated as having acute kidney injury, 159 transient azotemia, 15 stable CKD, and 312 normal renal function. Serum cystatin C and plasma neutrophil gelatinase-associated lipocalin (NGAL) were measured at index admission. After adjusting for clinical variables, the risk of developing CKD stage 3, as well as the risk of death, were increased in the acute kidney injury group (hazard ratio [HR], 5.7 [95% confidence interval, 3.8-8.7] and HR, 1.9 [95% confidence interval, 1.3-2.8], respectively). The addition of serum cystatin C increased the ability to predict the risk of developing CKD stage 3, and death (HR, 1.5 [1.1-2.0] and 1.6 [1.1-2.3], respectively). The addition of plasma NGAL resulted in no improvement in predicting CKD stage 3 or mortality (HR, 1.0 [0.7-1.5] and 1.2 [0.8-1.8], respectively). The risk of developing CKD stage 3 was also significantly increased in the transient azotemia group (HR, 2.4 [1.5-3.6]). Thus, an episode of community acquired acute kidney injury markedly increases the risk of CKD, and moderately increases the risk of death. Our findings highlight the importance of follow-up of patients with community acquired acute kidney injury, for potential early initiation of renal protective strategies.
authors.affiliation: Nephrology Department, Hospital Fernando Fonseca, Lisbon, Portugal; Centro de Estudos de Doenças Crónicas of NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Karina
authors.initials: K
authors.lastname: Soto
authors.affiliation: Nephrology Department, Hospital Fernando Fonseca, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Campos
authors.affiliation: Instituto Superior de Engenharia de Lisboa, Centro de Matemática e Aplicações, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Iola
authors.initials: I
authors.lastname: Pinto
authors.affiliation: Nephrology Department, Hospital Fernando Fonseca, Lisbon, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rodrigues
authors.affiliation: Emergency Department, Hospital Fernando Fonseca, Lisbon, Portugal.
authors.forename: Francisca
authors.initials: F
authors.lastname: Frade
authors.affiliation: Department of Biostatistics and Informatics, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Ana Luísa
authors.initials: AL
authors.lastname: Papoila
authors.affiliation: Department of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. Electronic address: prasad.devarajan@cchmc.org.
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D000071068:Lipocalin-2 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2
keywords: NGAL; acute kidney injury; biomarkers; chronic kidney disease; cystatin C