Acute kidney injury is a risk factor for subsequent proteinuria.

Parr SK, Matheny ME, Abdel-Kader K, Greevy RA, Bian A, Fly J, Chen G, Speroff T, Hung AM, Ikizler TA, Siew ED
Kidney Int. 2018 93 (2): 460-469

PMID: 28927644 · PMCID: PMC5796522 · DOI:10.1016/j.kint.2017.07.007

Acute kidney injury (AKI) is associated with subsequent chronic kidney disease (CKD), but the mechanism is unclear. To clarify this, we examined the association of AKI and new-onset or worsening proteinuria during the 12 months following hospitalization in a national retrospective cohort of United States Veterans hospitalized between 2004-2012. Patients with and without AKI were matched using baseline demographics, comorbidities, proteinuria, estimated glomerular filtration rate, blood pressure, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEI/ARB) use, and inpatient exposures linked to AKI. The distribution of proteinuria over one year post-discharge in the matched cohort was compared using inverse probability sampling weights. Subgroup analyses were based on diabetes, pre-admission ACEI/ARB use, and AKI severity. Among the 90,614 matched AKI and non-AKI pairs, the median estimated glomerular filtration rate was 62 mL/min/1.73m. The prevalence of diabetes and hypertension were 48% and 78%, respectively. The odds of having one plus or greater dipstick proteinuria was significantly higher during each month of follow-up in patients with AKI than in patients without AKI (odds ratio range 1.20-1.39). Odds were higher in patients with Stage II or III AKI (odds ratios 1.32-1.81) than in Stage I AKI (odds ratios 1.18-1.32), using non-AKI as the reference group. Results were consistent regardless of diabetes status or baseline ACEI/ARB use. Thus, AKI is a risk factor for incident or worsening proteinuria, suggesting a possible mechanism linking AKI and future CKD. The type of proteinuria, physiology, and clinical significance warrant further study as a potentially modifiable risk factor in the pathway from AKI to CKD.

Published by Elsevier Inc.

MeSH Terms (29)

Acute Kidney Injury Aged Angiotensin-Converting Enzyme Inhibitors Angiotensin II Type 1 Receptor Blockers Antihypertensive Agents Blood Pressure Comorbidity Databases, Factual Diabetes Mellitus Diabetic Nephropathies Disease Progression Female Glomerular Filtration Rate Hospitalization Hospitals, Veterans Humans Hypertension Kidney Male Middle Aged Prevalence Prognosis Proteinuria Renal Insufficiency, Chronic Retrospective Studies Risk Factors Severity of Illness Index Time Factors United States

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