Nonrecovery of Kidney Function and Death after Acute on... : Clinical Journal of the American Society of Nephrology (original) (raw)
Chronic Kidney Disease
Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure
Hsu, Chi-yuan; Chertow, Glenn M.; McCulloch, Charles E.; Fan, Dongjie; Ordon[Combining Tilde]ez, Juan D.; Go, Alan S.
Departments of *Medicine and ‡Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, †Department of Medicine, Stanford University, Stanford, and Divisions of §Research and ‖Nephrology, Kaiser Permanente of Northern California Oakland Medical Center, Oakland, California
Correspondence: Dr. Chi-yuan Hsu, Division of Nephrology, University of California, San Francisco, 521 Parnassus Avenue, C443, Box 0532, San Francisco, CA 94143-0532, CA. Phone: 415-353-2379; Fax: 415-476-3381; E-mail: [email protected]
Accepted March 13, 2009
Received October 29, 2008
Clinical Journal of the American Society of Nephrology 4(5):p 891-898, May 2009. | DOI: 10.2215/CJN.05571008
Abstract
Background and objectives: Relatively little is known about clinical outcomes, especially long-term outcomes, among patients who have chronic kidney disease (CKD) and experience superimposed acute renal failure (ARF; acute on chronic renal failure).
Design, setting, participants, & measurements: We tracked 39,805 members of an integrated health care delivery system in northern California who were hospitalized during 1996 through 2003 and had prehospitalization estimated GFR (eGFR) <45 ml/min per 1.73 m2. Superimposed ARF was defined as having both a peak inpatient serum creatinine greater than the last outpatient serum creatinine by ≥50% and receipt of acute dialysis.
Results: Overall, 26% of CKD patients who suffered superimposed ARF died during the index hospitalization. There was a high risk for developing ESRD within 30 d of hospital discharge that varied with preadmission renal function, being 42% among hospital survivors with baseline eGFR 30–44 ml/min per 1.73 m2 and 63% among hospital survivors with baseline eGFR 15–29 ml/min per 1.73 m2. Compared with patients who had CKD and did not experience superimposed ARF, those who did had a 30% higher long-term risk for death or ESRD.
Conclusions: In a large, community-based cohort of patients with CKD, an episode of superimposed dialysis-requiring ARF was associated with very high risk for nonrecovery of renal function. Dialysis-requiring ARF also seemed to be an independent risk factor for long-term risk for death or ESRD.
Copyright © 2009 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.
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