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Three-year outcomes after acute kidney injury: results of a prospective parallel group cohort study.

Three-year outcomes after acute kidney injury: results of a prospective parallel group cohort study.
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Horne KL, Packington R, Monaghan J, Reilly T, Selby NM,


Horne KL, Packington R, Monaghan J, Reilly T, Selby NM, (click to view)

Horne KL, Packington R, Monaghan J, Reilly T, Selby NM,

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BMJ open 2017 03 297(3) e015316 doi 10.1136/bmjopen-2016-015316
Abstract
OBJECTIVES
Using a prospective study design, we aimed to characterise the effect of acute kidney injury (AKI) on long-term changes in renal function in a general hospital population.

PARTICIPANTS
Hospitalised patients with AKI (exposed) and hospitalised patients without AKI (non-exposed), recruited at 3 months after hospital admission.

DESIGN
Prospective, matched parallel group cohort study, in which renal function and proteinuria were measured at 3 months, 1 year and 3 years.

SETTING
Single UK centre.

CLINICAL END POINTS
Clinical end points at 3 years were comparison of the following variables between exposed and non-exposed groups: renal function, prevalence of proteinuria and albuminuria and chronic kidney disease (CKD) progression/development at each time point. CKD progression was defined as a decrease in the estimated glomerular filtration rate (eGFR) of ≥25% associated with a decline in eGFR stage.

RESULTS
300 exposed and non-exposed patients were successfully matched 1:1 for age and baseline renal function; 70% of the exposed group had AKI stage 1. During follow-up, the AKI group had lower eGFR than non-exposed patients at each time point. At 3 years, the mean eGFR was 60.7±21 mL/min/1.73 m(2) in the AKI group compared with 68.4±21 mL/min/1.73 m(2) in the non-exposed group, p=0.003. CKD development or progression at 3 years occurred in 30 (24.6%) of the AKI group compared with 10 (7.5%) of the non-exposed group, p<0.001. Albuminuria was more common in the AKI group, and increased with AKI severity. Factors independently associated with CKD development/progression after AKI were non-recovery at 90 days, male gender, diabetes and recurrent AKI. CONCLUSIONS
AKI is associated with deterioration in renal function to 3 years, even in an unselected population with predominantly AKI stage 1. Non-recovery from AKI is an important factor determining long-term outcome.

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