Acute kidney injury significantly increased the risk of developing subsequent chronic kidney disease compared to non-AKI patients (OR 4.31), with similar risk elevation in perioperative and nonperioperative populations.
Meta-Analysis
Does acute kidney injury increase the risk of incident chronic kidney disease in perioperative and nonperioperative adult patients?
Acute kidney injury significantly increases the risk of incident chronic kidney disease, with similar risk elevations observed in both perioperative and nonperioperative patient populations.
Effect estimate: OR 4.31 (95% CI 3.01-6.17)
p-value: p=< 0.01
BACKGROUND: Recent research shows AKI increases the risk of incident CKD. We hypothesized that perioperative AKI may confer increased risk of subsequent CKD compared to nonperioperative AKI. METHODS: A MEDLINE search was performed for "AKI, CKD, chronic renal insufficiency, surgery, and perioperative" and related terms yielded 5209 articles. One thousand sixty-five relevant studies were reviewed. One thousand six were excluded because they were review, animal, or pediatric studies. Fifty-nine studies underwent full manuscript review by two independent evaluators. Seventeen met all inclusion criteria and underwent analysis. Two-by-two tables were constructed from AKI +/- and CKD +/- data. The R package metafor was employed to determine odds ratio (OR), and a random-effects model was used to calculate weighted ORs. Leave-1-out, funnel analysis, and structured analysis were used to estimate effects of study heterogeneity and bias. RESULTS: Nonperioperative studies included studies of oncology, percutaneous coronary intervention, and myocardial infarction patients. Perioperative studies comprised patients from cardiac surgery, vascular surgery, and burns. There was significant heterogeneity, but risk of bias was overall assessed as low. The OR for AKI versus non-AKI patients developing CKD in all studies was 4.31 (95% CI 3.01-6.17; p < 0.01). Nonperioperative subjects demonstrated OR 3.32 for developing CKD compared to non-AKI patients (95% CI 2.06-5.34; p < 0.01) while perioperative patients demonstrated OR 5.20 (95% CI 3.12-8.66; p < 0.01) for the same event. CONCLUSIONS: We conclude that studies conducted in perioperative and nonperioperative patient populations suggest similar risk of development of CKD after AKI.
Abdala et al. (Mon,) conducted a meta-analysis in Acute kidney injury (AKI). Acute kidney injury (AKI) vs. No acute kidney injury (non-AKI) was evaluated on Development of chronic kidney disease (CKD) (OR 4.31, 95% CI 3.01-6.17, p=< 0.01). Acute kidney injury significantly increased the risk of developing subsequent chronic kidney disease compared to non-AKI patients (OR 4.31), with similar risk elevation in perioperative and nonperioperative populations.