期刊
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
卷 30, 期 7, 页码 1271-1281出版社
AMER SOC NEPHROLOGY
DOI: 10.1681/ASN.2018101036
关键词
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资金
- Dr. Adam Linton Chair in Kidney Health Analytics
- Canadian Institutes of Health Research
- NIDDK [R01DK098233, R01DK101507, R01DK114014, K23DK100468, R03DK111881]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS) [UL1TR000003]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland [M01 RR-16500]
- NCATS component of the NIH [UL1TR000439]
- Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago CTSA grant [UL1RR029879]
- Tulane Center of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases [P20 GM109036]
- Kaiser Permanente NIH/National Center for Research Resources University of California, San Francisco Clinical and Translational Science Institute grant [UL1 RR-024131]
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902, U01DK082223, U01DK082185, U01DK082192, U01DK082183]
- Clinical and Translational Science Collaborative of Cleveland
- NIH roadmap for Medical Research [UL1TR000439]
Background Prior studies of adverse renal consequences of AKI have almost exclusively focused on eGFR changes. Less is known about potential effects of AKI on proteinuria, although proteinuria is perhaps the strongest risk factor for future loss of renal function. Methods We studied enrollees from the Assessment, Serial Evaluation, and Subsequent Sequelae of AKI (ASSESS-AKI) study and the subset of the Chronic Renal Insufficiency Cohort (CRIC) study enrollees recruited from Kaiser Permanente Northern California. Both prospective cohort studies included annual ascertainment of urine protein-to-creatinine ratio, eGFR, BP, and medication use. For hospitalized participants, we used inpatient serum creatinine measurements obtained as part of clinical care to define an episode of AKI (i.e., peak/nadir inpatient serum creatinine >= 1.5). We performed mixed effects regression to examine change in log-transformed urine protein-to-creatinine ratio after AKI, controlling for time-updated covariates. Results At cohort entry, median eGFR was 62.9 ml/min per 1.73 m(2) (interquartile range [IQR], 46.9-84.6) among 2048 eligible participants, and median urine protein-to-creatinine ratio was 0.12 g/g (IQR, 0.07-0.25). After enrollment, 324 participants experienced at least one episode of hospitalized AKI during 9271 person-years of follow-up; 50.3% of first AKI episodes were Kidney Disease Improving Global Outcomes stage 1 in severity, 23.8% were stage 2, and 25.9% were stage 3. In multivariable analysis, an episode of hospitalized AKI was independently associated with a 9% increase in the urine protein-to-creatinine ratio. Conclusions Our analysis of data from two prospective cohort studies found that hospitalization for an AKI episode was independently associated with subsequent worsening of proteinuria.
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