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Received August 1, 2007
Accepted on August 5, 2008

CLINICAL RESEARCH

Acute Kidney Injury Increases Risk of ESRD among Elderly

Areef Ishani ^*, Jay L. Xue ^*, Jonathan Himmelfarb , Paul W. Eggers , Paul L. Kimmel , Bruce A. Molitoris ^||, and Allan J. Collins ^*1

*United States Renal Data System Coordinating Center and Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Division of Nephrology, Maine Medical Center, Portland, Maine; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC; and ||Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana

¹ To whom correspondence should be addressed. E-mail: acollins{at}usrds.org.

	Abstract

Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up. Our cohort of 233,803 patients were hospitalized in 2000, were aged 67 yr on discharge, did not have previous ESRD or AKI, and were Medicare-entitled for 2 yr before discharge. In this cohort, 3.1% survived to discharge with a diagnosis of AKI, and 5.3 per 1000 developed ESRD. Among patients who received treatment for ESRD, 25.2% had a previous history of AKI. After adjustment for age, gender, race, diabetes, and hypertension, the hazard ratio for developing ESRD was 41.2 (95% confidence interval [CI] 34.6 to 49.1) for patients with AKI and CKD relative to those without kidney disease, 13.0 (95% CI 10.6 to 16.0) for patients with AKI and without previous CKD, and 8.4 (95% CI 7.4 to 9.6) for patients with CKD and without AKI. In summary, elderly individuals with AKI, particularly those with previously diagnosed CKD, are at significantly increased risk for ESRD, suggesting that episodes of AKI may accelerate progression of renal disease.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673