Acute Kidney Injury Episodes and Chronic Kidney Disease Risk in Diabetes Mellitus

BACKGROUND AND OBJECTIVES: Prior studies have examined long-term outcomes of a single acute kidney injury (AKI) event in hospitalized patients. We examined the effects of AKI episodes during multiple hospitalizations on the risk of chronic kidney disease (CKD) in a cohort with diabetes mellitus (DM). DESIGN, SETTING, PARTICIPANTS, mean baseline creatinine = 1.10 mg/dl SD, 0.3), 1822 required at least one hospitalization during the time under observation (mean = 61.2 months SD, 25). Five hundred thirty of 1822 patients experienced one AKI episode; 157 of 530 experienced ≥2 AKI episodes. In multivariable Cox proportional hazards models, any AKI versus no AKI was a risk factor for stage 4 CKD (hazard ratio HR, 3.56; 95% confidence interval CI, 2.76, 4.61); each AKI episode doubled that risk (HR, 2.02; 95% CI, 1.78, 2.30). CONCLUSIONS: AKI episodes are associated with a cumulative risk for developing advanced CKD in diabetes mellitus, independent of other major risk factors of progression.