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Incidence and Prognosis of Acute Kidney Diseases and Disorders Using an Integrated Approach to Laboratory Measurements in a Universal Health Care System.
James, Matthew T; Levey, Andrew S; Tonelli, Marcello; Tan, Zhi; Barry, Rebecca; Pannu, Neesh; Ravani, Pietro; Klarenbach, Scott W; Manns, Braden J; Hemmelgarn, Brenda R.
Afiliación
  • James MT; Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Levey AS; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Tonelli M; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Tan Z; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Barry R; Tufts Medical Center, Boston, Massachusetts.
  • Pannu N; Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Ravani P; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Klarenbach SW; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Manns BJ; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Hemmelgarn BR; Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
JAMA Netw Open ; 2(4): e191795, 2019 04 05.
Article en En | MEDLINE | ID: mdl-30951162
ABSTRACT
Importance Abnormal measurements of kidney function or structure may be identified that do not meet criteria for acute kidney injury (AKI) or chronic kidney disease (CKD) but nonetheless may require medical attention. The Kidney Disease Improving Global Outcomes Clinical Practice Guideline for AKI proposed criteria for the definition of acute kidney diseases and disorders (AKD), which include AKI; however, the incidence and prognosis of AKD without AKI remain unknown.

Objective:

To characterize the incidence and outcomes of AKD without AKI, with or without CKD. Design, Setting, and

Participants:

Retrospective cohort study including all adult residents in a universal health care system in Alberta, Canada, without end-stage kidney disease (ESKD) and with at least 1 serum creatinine measurement between January 1 and December 31, 2008, in a community or hospital setting. Data analysis took place in 2018. Main Outcomes and

Measures:

The Kidney Disease Improving Global Outcomes guideline definitions for CKD, AKI, and AKD based on serum creatinine, estimated glomerular filtration rate, and albuminuria criteria were applied to estimate the proportion of patients with CKD, AKI, and AKD without AKI, and combinations of the conditions. Patients were followed up for up to 8 years (study end date, June 31, 2016) to characterize their risks of mortality, development of new CKD, progression of preexisting CKD, and ESKD.

Results:

Among 1 109 099 Alberta residents included in the cohort, the mean (SD) age was 52.3 (17.6) years, and 43.0% were male. Findings showed that AKD without AKI was common (3.8 individuals without preexisting CKD and 0.6 with preexisting CKD per 100 population tested). In Cox proportional hazards and competing risks models over a median (interquartile range) of 6.0 (5.7-6.3) years of follow-up, AKD without AKI (compared with no kidney disease) was associated with higher risks of developing new CKD (37.4% vs 7.4%%; adjusted sub-hazard ratio [sHR], 3.17; 95% CI, 3.10-3.23), progression of preexisting CKD (49.5% vs 34.6%; adjusted sHR, 1.38; 95% CI, 1.33-1.44), ESKD (0.6% vs 0.1%; adjusted sHR, 8.56; 95% CI, 7.32-10.01), and death (25.8% vs 7.3%; adjusted hazard ratio, 1.42; 95% CI, 1.39-1.45). Conclusions and Relevance Criteria for AKD identified many patients who did not meet the criteria for CKD or AKI but had overall modestly increased risks of incident and progressive CKD, ESKD, and death. The clinical importance of AKD remains to be determined.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Tipo de estudio: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: JAMA Netw Open Año: 2019 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Renal Crónica / Lesión Renal Aguda Tipo de estudio: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: JAMA Netw Open Año: 2019 Tipo del documento: Article País de afiliación: Canadá