Episodes of acute kidney damage (AKD) are common in the community and may contribute to the development of chronic kidney disease (CKD), reports a study in Nephrology Dialysis Transplantation.
Using health care data from the Valencian Community in Spain from 2012 through 2016, the researchers identified more than 1.8 million community-dwelling adults (older than 23 years) with at least two serum creatinine measurements. Harmonized Kidney Disease: Improving Global Outcomes criteria were used to identify episodes of AKD, acute kidney injury (AKI), and CKD. AKD was defined as abnormalities of kidney structure and function present for less than 3 months. Changes in renal function and mortality were assessed, including the risk of developing CKD after recovery from AKD or AKI and the risk of declining kidney function in patients with previous CKD.
During 4.8 years of follow-up, 47,972 patients experienced a total of 56,850 episodes of AKD. The annual incidence rate was 4.3 per 1000 patients in patients without CKD and 12.56 per 1000 patients in those with previous CKD. Second episodes of AKD occurred in 10.3% of the group without CKD and in 18.4% of patients with CKD. Among patients with AKD, an annual incidence of AKI was 0.41 in patients without CKD versus 2.81 per 1000 patients with CKD.
CKD developed in 43.8% of patients with AKD who were initially free of CKD. Among those with previous CKD, 63.1% had disease progression (greater than 50% decline in estimated glomerular filtration rate). Factors associated with progression to CKD included the following: female sex, older age, overweight or obesity, and heart failure. The same factors were associated with progression of previous CKD, with a further effect of number of AKD episodes.
Of patients with episodes of AKI, 12.7% progressed to CKD, whereas 43.2% of those with previous CKD had disease progression (greater than 20% decline in estimated glomerular filtration rate). Overall, death occurred within 3 months of an episode of AKD in 7% of patients and within 3 months of an episode of AKI in 30.1%.
AKD is a recognized concern in hospitalized patients or among those who require hospitalization for various causes. Less is known about the occurrence and consequences of AKD in the community.
These data from Spain suggest that based on acute elevations of serum creatinine, AKD is common among community-dwelling adults and may contribute to the development or progression of CKD. “Patients meeting criteria for AKD in the community may not always require hospital admission, but a careful review of clinical circumstances, avoidable risk factors, and follow-up is still warranted,” the researchers write [Diaz J, et al. The impact of acute kidney damage in the community. Nephrol Dial Transpl, published online July 24, 2024. doi: 10.1093/ndt/gfae175].
