Recovery of kidney function after acute kidney disease: a multi-cohort analysis.

Sawhney, Simon; Ball, William; Bell, Samira; Black, Corri; Christiansen, Christian F.; Heide-Jørgensen, Uffe; Jensen, Simon K.; Lambourg, Emilie; Ronksley, Paul E.; Tan, Zhi; Tonelli, Marcello; James, Matthew T.

Abstract

There are no consensus definitions for evaluating kidney function recovery after acute kidney injury (AKI) and acute kidney disease (AKD), nor is it clear how recovery varies across populations and clinical subsets. We present a federated analysis of four population-based cohorts from Canada, Denmark and Scotland, 2011–18. We identified incident AKD defined by serum creatinine changes within 48 h, 7 days and 90 days based on KDIGO AKI and AKD criteria. Separately, we applied changes up to 365 days to address widely used e-alert implementations that extend beyond the KDIGO AKI and AKD timeframes. Kidney recovery was based on resolution of AKD and a subsequent creatinine measurement below 1.2× baseline. We evaluated transitions between non-recovery, recovery and death up to 1 year; within age, sex and comorbidity subgroups; between subset AKD definitions; and across cohorts. There were 464 868 incident cases, median age 67–75 years. At 1 year, results were consistent across cohorts, with pooled mortalities for creatinine changes within 48 h, 7 days, 90 days and 365 days (and 95% confidence interval) of 40% (34%–45%), 40% (34%–46%), 37% (31%–42%) and 22% (16%–29%) respectively, and non-recovery of kidney function of 19% (15%–23%), 30% (24%–35%), 25% (21%–29%) and 37% (30%–43%), respectively. Recovery by 14 and 90 days was frequently not sustained at 1 year. Older males and those with heart failure or cancer were more likely to die than to experience sustained non-recovery, whereas the converse was true for younger females and those with diabetes. Consistently across multiple cohorts, based on 1-year mortality and non-recovery, KDIGO AKD (up to 90 days) is at least prognostically similar to KDIGO AKI (7 days), and covers more people. Outcomes associated with AKD vary by age, sex and comorbidities such that older males are more likely to die, and younger females are less likely to recover.

Citation

SAWHNEY, S., BALL, W., BELL, S. BLACK, C., CHRISTIANSEN, C.F., HEIDE-JØRGENSEN, U., JENSEN, S.K., LAMBOURG, E., RONKSLEY, P.E., TAN, Z., TONELLI, M. and JAMES, M.T. 2024. Recovery of kidney function after acute kidney disease: a multi-cohort analysis. Nephrology dialysis transplantation [online], 39(3), pages 426-435. Available from: https://doi.org/10.1093/ndt/gfad180

• Journal Article Type: Article
• Acceptance Date: Jul 15, 2023
• Online Publication Date: Aug 12, 2023
• Publication Date: Mar 31, 2024
• Deposit Date: Mar 8, 2024
• Publicly Available Date: Mar 19, 2024
• Journal: Nephrology dialysis transplantation
• Print ISSN: 0931-0509
• Electronic ISSN: 1460-2385
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Issue: 3
• Pages: 426-435
• DOI: https://doi.org/10.1093/ndt/gfad180
• Keywords: Transplantation; Nephrology; AKI; CKD; Epidemiology; Prognosis; Recovery
• Public URL: https://rgu-repository.worktribe.com/output/2262228
• Additional Information: This article has been published with separate supporting information. This supporting information has been incorporated into a single file on this repository and can be found at the end of the file associated with this output.