The medical community generally believes that having an acute kidney injury (AKI) makes kidney function worse when people already have chronic kidney disease (CKD). But a new study suggests that may not be the case. In fact, a person with CKD who has a mild or moderate AKI may wind up with only minor decline in kidney function.
Researchers of California, San Francisco, looked at data on 3,150 people with CKD to try to find out if AKI is independently linked to kidney function in the future.
Over almost a four-year span, there were 612 AKIs in 433 people. When the researchers adjusted for factors such as prehospitalization estimated glomerular filtration rate (eGFR) slope and level of proteinuria, it didn’t show that having an AKI worsened kidney function. The link between having a mild or moderate AKI and worse kidney function was small, they found.
Because researchers didn’t find a separate association between a mild-to-moderate AKI and major loss of kidney function after an AKI, it doesn’t seem like preventing mild or moderate AKIs will stop CKD from progressing, they said.
The authors say their results indicate that kidney decline after AKI may have happened before the AKI.
An AKI (also called acute renal failure or ARF), is a sudden episode of kidney failure or damage that occurs within a few hours or days. An AKI causes waste to build up in your blood and makes it hard for kidneys to function optimally. The injury is quite common if people are older, or they are in a hospital. Some symptoms can include releasing only small amounts of urine, fatigue, shortness of breath, nausea, and swelling in the legs, ankles or eyes.
When someone presents with an AKI, doctors should focus on flattening the eGFR slope and treating proteinuria, the authors said. Diagnosing an AKI does present an opportunity to identify people at a high-risk for kidney decline and use evidence-based methods to slow the progression of CKD, they added.
F. Perry Wilson, MD, a nephrologist at Yale School of Medicine who wasn’t on the research team, told Medscape he was surprised at the study. But the findings don’t mean an AKI isn’t important. It reminds doctors that AKIs can happen to people who simply may be more susceptible, Wilson said. The study was published in Annals of Internal Medicine.
