Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure
Key result
An episode of superimposed dialysis-requiring acute renal failure in patients with chronic kidney disease increased the long-term risk for death or end-stage renal disease by 30% (HR 1.30).
Why the study?
Does superimposed acute renal failure requiring dialysis increase the risk of death or ESRD in hospitalized patients with chronic kidney disease?
Population
39,805 hospitalized patients with chronic kidney disease in an integrated health care delivery system in…
Comparison
Superimposed acute renal failure requiring acute… vs Patients with chronic kidney disease who did not…
Design
Cohort
Authors
Discussion
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Implication
May support enhanced post-AKI surveillance in CKD; extends prior observational data but leaves causal effects open for trials.
Study Design
Type
Cohort (n=39,805)
Multicenter
Yes
Structured PICO
Does superimposed acute renal failure requiring dialysis increase the risk of death or ESRD in hospitalized patients with chronic kidney disease?
P
Population
39,805 hospitalized patients with chronic kidney disease (prehospitalization eGFR <45 ml/min per 1.73 m2) in an integrated health care delivery system in northern California
I
Intervention
Superimposed acute renal failure (ARF) requiring acute dialysis
C
Comparator
Patients with chronic kidney disease who did not experience superimposed acute renal failure
O
Outcome
Long-term risk for death or end-stage renal disease (ESRD)hard clinical
Main Result
Effect estimate: HR 1.30 (95% CI 1.04-1.64)
In patients with chronic kidney disease, an episode of superimposed acute renal failure requiring dialysis is an independent risk factor for long-term death or progression to end-stage renal disease.
Limitations
- MDRD equation may misclassify certain patients with low eGFR
- May have failed to identify individuals who developed ESRD but were not initiated on dialysis
- Not able to define precisely the cause of ARF
- Did not have information regarding details of treatment such as dialysis dosage
- Potential residual confounding by severity of diabetes and other comorbidities
- Results may not be completely generalizable to the uninsured or to people in other health care settings
Cite This Study
Hsu et al. (2009) conducted a cohort in Chronic kidney disease (CKD) (n=39,805). Superimposed dialysis-requiring acute renal failure (ARF) vs. No superimposed ARF was evaluated on Long-term risk for death or ESRD (HR 1.30, 95% CI 1.04-1.64). An episode of superimposed dialysis-requiring acute renal failure in patients with chronic kidney disease increased the long-term risk for death or end-stage renal disease by 30% (HR 1.30).