Acute Kidney Injury and Chronic Kidney Disease Closely Entwined

AKI is sudden loss of kidney function; CKD develops slowly over many years. A comprehensive analysis by scientists at the National Institutes of Health (NIH; Bethesda, MD, USA) and George Washington University Medical Center (Washington DC, USA) suggests that each disease is a risk factor for developing the other. They share other risk factors as well as causes for the diseases to become worse, and also outcomes. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; Bethesda, MD, USA) recommend that people with either disease should be monitored for both.

Analyzing large observational studies, the scientists saw that CKD and AKI were also risk factors for development of cardiovascular disease, progressive decreases in kidney function that can lead to kidney failure, diminished quality of life, disability, and premature death. The findings were published July 3, 2014, in the New England Journal of Medicine (NEJM).

The investigators found that new cases of AKI are increasing among hospitalized patients, possibly due to the aging population and rising rates of sepsis, a potentially life-threatening blood infection that can cause AKI. However, they found that preexisting CKD is the most important risk factor for AKI, increasing the odds by as much as 10 times. Conversely, patients with AKI had a 13-fold increased risk of CKD that progressed to kidney failure, compared to those without AKI. And the risk of kidney failure rose to 40 times if patients had both AKI and preexisting CKD.

Observational data in the 2007 US Renal Data System Annual Data Report suggest that few people with AKI see physicians and/or cardiologists after being discharged from hospital.

Paul Kimmel, MD, director of the Acute Kidney Injury program at the NIH's National Institute of Diabetes and Digestive and Kidney Diseases and lead author of the NEJM article, commented, "Physicians have been taught for decades to consider AKI and CKD as separate, but our study shows that we have to approach the two diseases as interconnected. When people have chronic kidney disease, their doctors should be on the lookout for acute kidney injury. And when people have recovered from acute kidney injury, they should promptly follow up with their doctor––and a kidney specialist to monitor their kidney function for long-term consequences related to progression of CKD."

The NIDDK, a component of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. It covers the full range of medicine afflicting people of all ages and ethnic groups. These diseases represent some of the most common, severe, and disabling conditions affecting Americans.

Related Links:
National Institutes of Health
George Washington University Medical Center 
National Institute of Diabetes and Digestive and Kidney Diseases