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Acute kidney injury may increase risk for coronary events, mortality
Acute kidney injury requiring temporary dialysis appears to be associated with increased long-term risk of coronary events and death among hospitalized patients, according to findings in a population-based cohort study.
The researchers evaluated data on 4,869 hospitalized patients who recovered from acute kidney injury requiring dialysis between 1999 and 2008, along with a control group of 4,869 matched participants without acute kidney injury. The mean age for the entire cohort was 63.6 years.
During a mean follow-up of 3.31 years, incidence rates of coronary events per 1,000 person-years were 19.8 in the acute kidney injury recovery group and 10.3 in the non-injury group. The recovery group also demonstrated higher incidence rates for each individual element within the classification of coronary events, particularly nonfatal MI. All-cause mortality incidence rates were 178.6 per 1,000 person-years in the recovery group and 96.4 per 1,000 person-years in the non-injury group.
A significant association was observed between acute kidney injury and increased long-term risk of coronary events (HR=1.67; 95% CI, 1.36-2.04), regardless of age, sex, congestive HF, diabetes, chronic kidney disease or end-stage renal disease. Risk for all-cause mortality was also significantly higher in the kidney injury group (HR=1.67; 95% CI, 1.57-1.79), independent of the effects of progression to chronic kidney disease and end-stage renal disease.
In addition, the increased risk for coronary events from acute kidney injury was similar to that from diabetes. In both patients with diabetes alone and in those with acute kidney injury alone, a similar risk for de novo coronary events was observed after discharge from the hospital (P=.23).
The researchers wrote that their findings suggest that acute kidney injury may prompt “a cascade of perturbations that is never completely resolved.”
“The role of [acute kidney injury] as a cause of mortality is evidenced by the fact that patients experiencing temporary dialysis and recovery from [acute kidney injury] have higher risk of coronary events than those patients without experience of severe [acute kidney injury],” the researchers wrote. “A comprehensive treatment strategy during hospitalization or even after discharge for [acute kidney injury] patients is necessary to reduce the risk of ensuing coronary events and subsequent mortality.”
Disclosure: The researchers report no relevant financial disclosures.