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Study finds AKI independently associated with increased risk of CV events
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According to a study in the Clinical Journal of the American Society of Nephrology, acute kidney injury in hospitalized adults was independently linked with a greater risk of CV events, especially heart failure, 1 year after hospital discharge.
“Our results highlight subsequent heart failure as a key risk for patients who experienced acute kidney injury in the hospital,” Alan S. Go, MD, lead author of the study from Kaiser Permanente Northern California, said in a press release from the American Society of Nephrology. “Earlier detection of heart failure symptoms in these patients could potentially save lives.”
Researchers performed a matched cohort of 146,931 hospitalized adults. Overall, 31,245 patients experienced AKI. Investigators used the Kidney Disease: Improving Global Outcomes diagnostic criteria to determine AKI.
“At 365 days postdischarge, AKI was independently associated with higher rates of the composite outcome of hospitalization for heart failure and atherosclerotic events ... even after adjustment for demographics, comorbidities, pre-admission [estimated glomerular filtration rate] eGFR and proteinuria, heart failure and sepsis complicating the hospitalization, ICU admission, length of stay and predicted in-hospital mortality,” the investigators wrote.
Researchers noted that 10,605 patients experienced heart failure and atherosclerotic events within the first year after discharge.
In an accompanying editorial, Steven G. Coca, DO, MS, from the Icahn School of Medicine at Mount Sinai, wrote, “While the association between AKI and atherosclerotic events was not statistically significant, the adjusted hazard ratio for subsequent heart failure was 1.44 (95% CI 1.33-1.56), after adjusting for demographics, comorbidities, procedures, laboratory variables, length of ICU stay in the ICU/hospital and predicted mortality score. The amount and degree of adjustment for the potential confounders was probably the most robust of any large retrospective study of AKI that has been published, and the authors should be commended for this level of rigor.”
However, Coca noted the absolute difference in the risk of congestive heart failure associated with AKI was 2% and that residual confounding could explain the results. According to the press release, Coca also noted that recently published studies are not fully supportive of the paradigm that AKI is the driver or mediator of adverse outcomes seen in large epidemiologic studies. – by Jake Scott
Reference:
Disclosures: Go reports he received a research grant through his institution from Astra-Zeneca. Please see the study for all other authors’ relevant financial disclosures.
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Go AS, et al. Clin J Am Soc Nephrol. 2018;doi:10.2215/CJN.12591117
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