Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/21642
Title: Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure.
Authors: See, Emily J;Jayasinghe, Kushani;Glassford, Neil;Bailey, Michael;Johnson, David W;Polkinghorne, Kevan R;Toussaint, Nigel D;Bellomo, Rinaldo
Affiliation: Department for Continuing Education, University of Oxford, Oxford, UK
Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Nephrology, Monash Health, Clayton, Victoria, Australia
School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
Australasian Kidney Trials Network, Brisbane, Queensland, Australia
Translational Research Institute, Brisbane, Queensland, Australia
Department of Medicine, Monash University, Melbourne, Victoria, Australia
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Jan-2019
EDate: 2018-11-23
Citation: Kidney international 2019; 95(1): 160-172
Abstract: Reliable estimates of the long-term outcomes of acute kidney injury (AKI) are needed to inform clinical practice and guide allocation of health care resources. This systematic review and meta-analysis aimed to quantify the association between AKI and chronic kidney disease (CKD), end-stage kidney disease (ESKD), and death. Systematic searches were performed through EMBASE, MEDLINE, and grey literature sources to identify cohort studies in hospitalized adults that used standardized definitions for AKI, included a non-exposed comparator, and followed patients for at least 1 year. Risk of bias was assessed by the Newcastle-Ottawa Scale. Random effects meta-analyses were performed to pool risk estimates; subgroup, sensitivity, and meta-regression analyses were used to investigate heterogeneity. Of 4973 citations, 82 studies (comprising 2,017,437 participants) were eligible for inclusion. Common sources of bias included incomplete reporting of outcome data, missing biochemical values, and inadequate adjustment for confounders. Individuals with AKI were at increased risk of new or progressive CKD (HR 2.67, 95% CI 1.99-3.58; 17.76 versus 7.59 cases per 100 person-years), ESKD (HR 4.81, 95% CI 3.04-7.62; 0.47 versus 0.08 cases per 100 person-years), and death (HR 1.80, 95% CI 1.61-2.02; 13.19 versus 7.26 deaths per 100 person-years). A gradient of risk across increasing AKI stages was demonstrated for all outcomes. For mortality, the magnitude of risk was also modified by clinical setting, baseline kidney function, diabetes, and coronary heart disease. These findings establish the poor long-term outcomes of AKI while highlighting the importance of injury severity and clinical setting in the estimation of risk.
URI: http://ahro.austin.org.au/austinjspui/handle/1/21642
DOI: 10.1016/j.kint.2018.08.036
ORCID: 0000-0002-1650-8939
PubMed URL: 30473140
Type: Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Subjects: acute kidney injury
chronic kidney disease
death
end-stage kidney disease
major adverse kidney event
Appears in Collections:Journal articles

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