Table 2.
Studies of mortality outcomes in AKI by pre-AKI and post-AKI kidney function
| Mortality | N | Clinical setting | Design | AKI exposure | Comparator | Follow-up | Pre-AKI baseline separation | Post-AKI recovery separation | Recovery definition | Findings |
|---|---|---|---|---|---|---|---|---|---|---|
| Schiffl and Fischer11 | 226 | ITU | Cohort | Acute RRT | None | 5 years | CKD excluded | Y | Within 10% baseline | Mortality 83% without recovery, 33% with recovery HR without vs with recovery 4.1† (no non-AKI comparator) |
| Triverio et al17 | 95 | ITU | Cohort | Acute RRT | None | 3 years | Y | Y | eGFR>60 | Mortality 50% if baseline CKD, 29% if eGFR <60 at discharge, 18% if no renal impairment before or after AKI |
| Bucaloiu et al12 | 1610 | Unselected | Cohort | Cr rise >50% | No AKI | 3.3 years* | CKD excluded | Recovered only | Within 10% baseline | HR Mortality 1.48† |
| Hsu et al13 | 782 | Unselected | Cohort | Acute RRT | CKD with no RRT | 4 years | CKD only (eGFR<45) | N | – | HR composite end point of ESKD or mortality 1.3† |
| Ishani et al18 | 7197 | Unselected | Cohort | Code | No AKI or CKD code | 2 years | Y by code alone | N | – | HR mortality vs no AKI or CKD AKI and CKD 3.24†, AKI 2.48†, CKD 1.45† |
| Jones et al14 | 719 | Unselected | Cohort | Code | No AKI | 2.5 years* | CKD excluded | Recovered only | Within 10% baseline | HR Mortality 1.08 |
| Lafrance et al19 | 82 711 | Unselected | Cohort | Cr rise >50% | No AKI | 2.34 years* | Y | Recovered only in a subanalysis | Within 10% baseline | HR mortality for AKI vs no AKI in 90-day survivors 1.41† Subgroup of 6-month survivors 1.13† Subgroup with recovery 1.47† |
| Ponte et al21 | 177 | Unselected | Cohort | Cr rise from<1.4 mg/dL to >2 | None | 7.2 years* | CKD excluded (Cr >1.4 mg/dL) | Y | Cr<1.4 mg/dL | 10-year mortality 40% with recovery, 57% without recovery |
| Lindsay et al35 | 179 | Cardiac | Cohort | Cr rise 50% from<1.2 mg/dL | No AKI | 1 year | CKD excluded (cr >1.2 mg/dL) | N | – | 1-year mortality 9.5% AKI, 2.7% no-AKI |
| Maioli et al15 | 167 | Cardiac | Cohort | Cr rise (0.5 mg/dL by 3 days) | No AKI | 3.8 years* | CKD only (eGFR <60) | Y | Within 25% baseline at 3 months | HR mortality for AKI with recovery1.3†, without recovery 2.3† |
| Brown et al22 | 1886 | Postoperative | Cohort | Cr rise 0.3 mg/dL or 50% | No AKI | 2.6 years* | N | Y | Number of days AKI definition met | HR mortality for AKI vs no AKI by AKI duration 1–2 days 1.51†, 3–6 days 1.74†, >7 days 3.45†, persistent 5.75† |
| Coca et al23 | 6257 | Postoperative | Cohort | Cr rise 0.3 mg/dL or 50% | No AKI | 3.8 years* | N | Y | Number of days AKI definition met | HR mortality for AKI vs no AKI by AKI duration <2 days 1.15†, 3–6 days 1.5†, >7 days any duration with RRT 2.10† |
| Kheterpal et al16 | 101 | Postoperative | Cohort | Cr clearance fall to<50 | No AKI | 1 year | CKD excluded | N | – | 1-year mortality 12% AKI, 9% no AKI |
| Loef et al24 | 145 | Postoperative | Cohort | Cr rise 25% | No AKI | 100 months | N | Y | “Improved to or below the preoperative level” | HR mortality for AKI 1.63†, AKI with recovery 1.66†, AKI without recovery 1.72†, non-recovery vs recovery 1.22 (not significant) |
| Mehta et al25 | 2083 | Postoperative | Cohort | Cr rise 50% or 0.7 mg/dL | No AKI | 7 years* | N | Y | AKI definition no longer met at 7 days | HR mortality for AKI with recovery 1.21†, without recovery 1.47† |
| Wu et al20 | 4393 | Postoperative | Cohort | Cr rise >50% | No AKI and no CKD | 4.76 years* | Y by GFR>/<45 | Y | Within 50% baseline | HR mortality for AKI only 1.94†, CKD only 2.64†, AKI and CKD 3.28† Stratified by recovery AKI and CKD with recovery 3.0†, without recovery 4.59† AKI only with recovery 1.96†, without recovery 2.18† CKD without AKI 2.59† |
*Mean/median.
†Statistically significant p<0.05.
–, Outcome not addressed by study; AKI, acute kidney injury; CKD, chronic kidney disease; Cr, serum creatinine; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease (dialysis >90 days); ITU, intensive therapy unit; N, outcome addressed but not per quality criterion; RRT, renal replacement therapy.