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).
Cohort (n=39,805)
Yes
Effect estimate: HR 1.30 (95% CI 1.04-1.64)
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) or =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 m(2) and 63% among hospital survivors with baseline eGFR 15-29 ml/min per 1.73 m(2). 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.
Hsu et al. (Thu,) 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).