OAKLAND, CA — Patients with chronic kidney disease are at higher than previously realized risk of needing permanent dialysis if they require hospital-based dialysis for injury to the kidneys, according to a Kaiser Permanente study. The study appears today in the online version of The Clinical Journal of the American Society of Nephrology.
This study is among the first to focus on clinical outcomes, especially long-term outcomes, among patients who have chronic kidney disease and experience superimposed acute kidney injury in the hospital.
This finding may cause clinicians to re-think traditional decision-making for patients who develop acute need for hospital-based dialysis, said the study’s lead author Chi-yuan Hsu, MD, an associate professor with the UCSF Division of Nephrology and an adjunct investigator with the Kaiser Permanente Division of Research. “For hospitalized patients who experienced acute kidney injury as a result of problems such as severe infection or a complication of bypass surgery, the conventional teaching has been that if the patient recovers, their kidneys will also recover, even if the acute injury is so severe as to need dialysis. Our study shows that this is not true for many patients with pre-existing chronic kidney disease,” said Hsu. “Among these patients, many are tipped over into end-stage kidney disease and never recover kidney function.”
In the study, 26 percent of patients who had chronic kidney disease and experienced a superimposed acute failure of their kidneys in the hospital died during their hospitalization. Among the survivors, over half of became dependent on long-term dialysis after hospital discharge.
The researches tracked 39, 805 adult member of the Kaiser Permanente of Northern California who were hospitalized from 1996 through 2003 and who had kidney function measured before hospitalization. Kaiser Permanente is a large, integrated health care delivery system that currently insures more than 3.2 million members.
The senior author of the paper is Alan S. Go, MD, director of the Comprehensive Clinical Research Unit and senior research scientist at the Kaiser Permanente Division of Research.
Additional authors on the study include Glenn M. Chertow, MD, department of medicine, Stanford University; Charles E. Mcculloch, PhD, UCSF departments of epidemiology and biostatistics; Dongjie Fan, MSPH, Kaiser Permanente Division of Research; and Juan D. Ordonez, MD, division of nephrology, Kaiser Permanente Oakland Medical Center. Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases.