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Acute kidney injury will not worsen subsequent chronic kidney disease

Study co-led by Kaiser Permanente researchers provides new information on the long-term impact of acute kidney injury

New research from the Chronic Renal Insufficiency Cohort (CRIC) study, co-led by the Kaiser Permanente Northern California Division of Research, found that mild-to-moderate acute kidney injury does not predict worsening of kidney function. In fact, the study, published in the Annals of Internal Medicine, suggests that much of the kidney disease observed after an acute kidney injury episode may have already been present.

Alan S. Go, MD

CRIC is an ongoing prospective study of patients with kidney disease. The new study was designed to determine whether an acute kidney injury episode in the hospital is associated with subsequent kidney outcomes. The new study included 3,150 people with chronic kidney disease. Over 3.9 years of follow up, 612 acute kidney injury episodes were observed in 433 study participants with chronic kidney disease. After taking into account patient characteristics, such as the level of protein in the urine, the study found mild-to-moderate acute kidney injury did not predict worsening of subsequent kidney function.

“These results from our prospective study challenge the paradigm that all acute kidney injury episodes lead to worse kidney outcomes and highlight the importance of knowing a patient’s long-term trajectory of kidney function before being hospitalized,” said co-author Alan S. Go, MD, associate director of the Kaiser Permanente Northern California Division of Research.

The presence of acute kidney injury — an abrupt decline in kidney function, often in the setting of an acute illness — has long been believed to be a risk factor for worsening kidney disease. However, many of these prior studies that concluded acute kidney injury was a risk factor had limitations that may have biased the results.

Chi-yuan Hsu, MD, MSc, an adjunct investigator with the Division of Research and a professor of Medicine at the University of California, San Francisco, was the senior author of the new study.

Read the UCSF news story.

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