Mortality and recovery associated with kidney failure due to acute kidney injury

Silvi Shah; Anthony C Leonard; Kathleen Harrison; Karthikeyan Meganathan; Annette L Christianson; Charuhas V Thakar

doi:10.2215/CJN.11200919

Mortality and recovery associated with kidney failure due to acute kidney injury

Silvi Shah, Anthony C Leonard, Kathleen Harrison, Karthikeyan Meganathan, Annette L Christianson, Charuhas V Thakar

Research output: Contribution to journal › Article › peer-review

63 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: AKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.

RESULTS: Mean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0-3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3-6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.

CONCLUSIONS: Kidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.

Original language	English
Pages (from-to)	995-1006
Number of pages	12
Journal	Clinical Journal of the American Society of Nephrology
Volume	15
Issue number	7
DOIs	https://doi.org/10.2215/CJN.11200919
Publication status	Published - 01 Jul 2020
Externally published	Yes

Bibliographical note

Keywords

Acute Kidney Injury/complications
Adolescent
Adult
Black or African American/statistics & numerical data
Aged
Aged, 80 and over
Asian/statistics & numerical data
Databases, Factual
Female
Hispanic or Latino/statistics & numerical data
Humans
Male
Middle Aged
Recovery of Function
Renal Dialysis/statistics & numerical data
Renal Insufficiency/ethnology
Retrospective Studies
Sex Factors
United States/epidemiology
White People/statistics & numerical data
Young Adult
American Indian or Alaska Native/statistics & numerical data

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2215/CJN.11200919Licence: Unspecified

Cite this

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title = "Mortality and recovery associated with kidney failure due to acute kidney injury",

abstract = "BACKGROUND AND OBJECTIVES: AKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.DESIGN, SETTING, PARTICIPANTS, \& MEASUREMENTS: Using the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.RESULTS: Mean age was 63±15 years, and 32,598 (3\%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0-3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95\% confidence interval, 1.24 to 1.32) and 3-6 months (adjusted hazard ratio, 1.16; 95\% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35\%) eventually recovered their kidney function, 95\% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95\% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95\% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95\% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95\% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95\% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.CONCLUSIONS: Kidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.",

keywords = "Acute Kidney Injury/complications, Adolescent, Adult, Black or African American/statistics \& numerical data, Aged, Aged, 80 and over, Asian/statistics \& numerical data, Databases, Factual, Female, Hispanic or Latino/statistics \& numerical data, Humans, Male, Middle Aged, Recovery of Function, Renal Dialysis/statistics \& numerical data, Renal Insufficiency/ethnology, Retrospective Studies, Sex Factors, United States/epidemiology, White People/statistics \& numerical data, Young Adult, American Indian or Alaska Native/statistics \& numerical data",

author = "Silvi Shah and Leonard, \{Anthony C\} and Kathleen Harrison and Karthikeyan Meganathan and Christianson, \{Annette L\} and Thakar, \{Charuhas V\}",

note = "Copyright {\textcopyright} 2020 by the American Society of Nephrology.",

year = "2020",

month = jul,

day = "1",

doi = "10.2215/CJN.11200919",

language = "English",

volume = "15",

pages = "995--1006",

journal = "Clinical Journal of the American Society of Nephrology",

issn = "1555-9041",

publisher = "Lippincott Williams and Wilkins",

number = "7",

}

TY - JOUR

T1 - Mortality and recovery associated with kidney failure due to acute kidney injury

AU - Shah, Silvi

AU - Leonard, Anthony C

AU - Harrison, Kathleen

AU - Meganathan, Karthikeyan

AU - Christianson, Annette L

AU - Thakar, Charuhas V

PY - 2020/7/1

Y1 - 2020/7/1

N2 - BACKGROUND AND OBJECTIVES: AKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.RESULTS: Mean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0-3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3-6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.CONCLUSIONS: Kidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.

AB - BACKGROUND AND OBJECTIVES: AKI requiring dialysis is a contributor to the growing burden of kidney failure, yet little is known about the frequency and patterns of recovery of AKI and its effect on outcomes in patients on incident dialysis.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the US Renal Data System, we evaluated a cohort of 1,045,540 patients on incident dialysis from January 1, 2005 to December 31, 2014, retrospectively. We examined the association of kidney failure due to AKI with the outcome of all-cause mortality and the associations of sex and race with kidney recovery.RESULTS: Mean age was 63±15 years, and 32,598 (3%) patients on incident dialysis had kidney failure due to AKI. Compared with kidney failure due to diabetes mellitus, kidney failure attributed to AKI was associated with a higher mortality in the first 0-3 months following dialysis initiation (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24 to 1.32) and 3-6 months (adjusted hazard ratio, 1.16; 95% confidence interval, 1.11 to 1.20). Of the patients with kidney failure due to AKI, 11,498 (35%) eventually recovered their kidney function, 95% of those within 12 months. Women had a lower likelihood of kidney recovery than men (adjusted hazard ratio, 0.86; 95% confidence interval, 0.83 to 0.90). Compared with whites, blacks (adjusted hazard ratio, 0.68; 95% confidence interval, 0.64 to 0.72), Asians (adjusted hazard ratio, 0.82; 95% confidence interval, 0.69 to 0.96), Hispanics (adjusted hazard ratio, 0.82; 95% confidence interval, 0.76 to 0.89), and Native Americans (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.95) had lower likelihoods of kidney recovery.CONCLUSIONS: Kidney failure due to AKI confers a higher risk of mortality in the first 6 months compared with kidney failure due to diabetes or other causes. Recovery within 12 months is common, although less so among women than men and among black, Asian, Hispanic, and Native American patients than white patients.

KW - Acute Kidney Injury/complications

KW - Adolescent

KW - Adult

KW - Black or African American/statistics & numerical data

KW - Aged

KW - Aged, 80 and over

KW - Asian/statistics & numerical data

KW - Databases, Factual

KW - Female

KW - Hispanic or Latino/statistics & numerical data

KW - Humans

KW - Male

KW - Middle Aged

KW - Recovery of Function

KW - Renal Dialysis/statistics & numerical data

KW - Renal Insufficiency/ethnology

KW - Retrospective Studies

KW - Sex Factors

KW - United States/epidemiology

KW - White People/statistics & numerical data

KW - Young Adult

KW - American Indian or Alaska Native/statistics & numerical data

U2 - 10.2215/CJN.11200919

DO - 10.2215/CJN.11200919

M3 - Article

C2 - 32554731

SN - 1555-9041

VL - 15

SP - 995

EP - 1006

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

IS - 7

ER -

Mortality and recovery associated with kidney failure due to acute kidney injury

Abstract

Bibliographical note

Keywords

UN SDGs

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