Three-year risk of cardiovascular disease among intensive care patients with acute kidney injury: a population-based cohort studyReport as inadecuate




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Critical Care

, 18:492

First Online: 14 October 2014Received: 22 April 2014Accepted: 05 August 2014

Abstract

IntroductionAcute kidney injury AKI is common among intensive care unit ICU patients, but follow-up data on subsequent risk of cardiovascular disease remain sparse. We examined the impact of AKI on three-year risk of first-time heart failure, myocardial infarction MI, and stroke among ICU patients surviving to hospital discharge, and whether this risk is modified by renal recovery before hospital discharge.

MethodsWe used population-based medical registries to identify all adult patients admitted to an ICU in Northern Denmark between 2005 and 2010 who survived to hospital discharge and who had no previous or concurrent diagnosis of heart failure, MI, or stroke. AKI was defined according to the creatinine criteria in the Kidney Disease Improving Global Outcomes classification. We computed the three-year cumulative risk of hospitalization with heart failure, MI, and stroke for patients with and without AKI and the hazard ratios HRs, using a Cox model adjusted for potential confounders.

ResultsAmong 21,556 ICU patients surviving to hospital discharge, 4,792 22.2% had an AKI episode. Three-year cumulative risk of heart failure was 2.2% in patients without AKI, 5.0% for AKI stage 1, and 5.0% for stages 2 to 3. The corresponding adjusted HRs were 1.33 95% confidence interval CI, 1.06 to 1.66 for patients with AKI stage 1 and 1.45 95% CI, 1.14 to 1.84 for AKI stages 2 to 3, compared to patients without AKI. The three-year cumulative MI risk was 1.0% for patients without AKI, 1.8% for patients with AKI stage 1 and 2.3% for patients with AKI stages 2 to 3. The adjusted HR for MI was 1.04 95% CI, 0.71 to 1.51 for patients with AKI stage 1 and 1.51 95% CI, 1.05 to 2.18 for patients with AKI stages 2 to 3, compared with patients without AKI. We found no association between AKI and stroke. The increased risk of heart failure and MI persisted in patients with renal recovery before discharge, although it was less pronounced than in patients without renal recovery.

ConclusionsICU patients surviving any stage of AKI are at increased three-year risk of heart failure, but not stroke. Only AKI stages 2 to 3 are associated with increased MI risk.

AbbreviationsAKIacute kidney injury

ATCanatomic therapeutic chemical classification system

CABGcoronary arterial bypass grafting

CIconfidence interval

CKDchronic kidney disease

DNRPDanish National Registry of Patients

eGFRestimated glomerular filtration rate

HFheart failure

HIVhuman immunodeficiency virus

HRhazard ratio

ICD-10International Classification of Disease, 10 revision

ICUintensive care unit

IQRinterquartile range

KDIGOKidney Disease Improving Global Outcome

MDRDModification of Diet in Renal Disease

MImyocardial infarction

NSAIDSnonsteroidal anti-inflammatory drugs

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0492-2 contains supplementary material, which is available to authorized users.

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Author: Henrik Gammelager - Christian Fynbo Christiansen - Martin Berg Johansen - Else Tønnesen - Bente Jespersen - Henrik Toft 

Source: https://link.springer.com/







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