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Chronic kidney disease following acute kidney injury—risk and outcomes

Nature Reviews Nephrology volume 9, pages 77–85 (2013)Cite this article

Abstract

In the past two decades, a substantial increase in the incidence of acute kidney injury (AKI) and kidney injury requiring dialysis has occurred in North America. This increase has coincided with an increase in the incidence of end-stage renal disease (ESRD), which has exceeded that expected based upon the prevalence of chronic kidney disease (CKD). In order to better understand the association between these conditions, there has been a proliferation of studies that have examined the risks of incident and progressive CKD following AKI. Animal studies have shown that failed differentiation of epithelial cells following renal ischaemia–reperfusion injury might lead to tubulointerstitial fibrosis, supporting a biological mechanism linking AKI and CKD. Strong and consistent associations between AKI and incident CKD, progression of CKD and incident ESRD have also been shown in epidemiological studies. In this Review, we summarize the wealth of available data on the relationship between AKI and CKD, and discuss the implications of these findings for the long-term clinical management of patients following AKI. We also identify areas of active investigation and future directions for research.

Key Points

  • The increase in incidence of acute kidney injury (AKI) in the past two decades has coincided with an increase in the incidence of end-stage renal disease (ESRD)

  • Epidemiological studies have consistently shown that AKI is a risk factor for incident chronic kidney disease (CKD), progression of CKD and incident ESRD

  • The 2012 KDIGO AKI guidelines recommend that patients should be evaluated 3 months after an episode of AKI to assess recovery, development of incident CKD or worsening of pre-existing CKD

  • The development of new tools to identify patients at high risk of progressive CKD after AKI is required

  • Further research into interventions that could potentially slow the progression of kidney disease and improve long-term patient outcomes after AKI is required

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Figure 1: Rate of change in eGFR in patients before and after coronary angiography, according to AKI status.

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Authors and Affiliations

  1. Department of Medicine, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, T2N 2T9, AB, Canada

    Kelvin C. W. Leung

  2. Department of Community Health Sciences, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, T2N 2T9, AB, Canada

    Matthew T. James

  3. Department of Medicine, University of Alberta, 7-129 Clinical Sciences Building, 11350–11383 Avenue, Edmonton, T6G 2G3, AB, Canada

    Marcello Tonelli

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K. C. W. Leung and M. T. James researched the data for the article, provided substantial contribution to discussions of the content, wrote the article and reviewed and/or edited the manuscript before submission. M. Tonelli provided substantial contributions to discussions of the content and reviewed and/or edited the manuscript before submission.

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Correspondence to Matthew T. James.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Studies that have examined the association between AKI and the subsequent risk of CKD or ESRD (DOC 63 kb)

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Leung, K., Tonelli, M. & James, M. Chronic kidney disease following acute kidney injury—risk and outcomes. Nat Rev Nephrol 9, 77–85 (2013). https://doi.org/10.1038/nrneph.2012.280

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