Kidney Conditions More Closely Related Than Previously Thought

Acute kidney injury increased risk of chronic kidney disease and vice versa

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Conventional medical wisdom regarding acute kidney injury and chronic kidney disease considers the two conditions separately. But relying on dated practices doesn’t always result in the best patient care.

A new study suggests that in addition to being closely related, each of these kidney conditions may increase the risk of developing the other.

Patients who had pre-existing cases of both acute kidney injury and chronic kidney disease were 40 times more likely to have kidney failure than patients without the conditions.

"Consult a nephrologist about managing kidney disease."

Paul Kimmel, MD, director of the Acute Kidney Injury program at the National Institute of Diabetes and Digestive and Kidney Diseases, led this research.

The researchers set out to analyze the relationship between acute kidney injury and chronic kidney disease.

Acute kidney injury is the sudden loss of kidney function, whereas chronic kidney disease develops over time. Risk factors for both conditions include aging, diabetes and high blood pressure.

To conduct their review, Dr. Kimmel and team considered several observational studies, including the 2007 United States Renal Data System Annual Data Report, which looked at data from more than 200,000 patients around the country.

The researchers found that chronic kidney disease was the single most important risk factor for developing acute kidney injury. Patients with pre-existing chronic kidney disease were 10 times more likely to develop acute kidney injury than patients without chronic kidney disease.

Similarly, patients with acute kidney injury were 13 times more likely to develop chronic kidney disease that could progress to kidney failure when compared to patients without acute kidney injury.

For patients who had both acute kidney injury and chronic kidney disease, the risk of kidney failure was 40 times higher than in patients without those two conditions.

Further, Dr. Kimmel and his colleagues found that instances of acute kidney injury were increasing probably due to increasing age of the general population and increasing cases of the blood infection sepsis, which can cause acute kidney injury.

The researchers also found that chronic kidney disease and acute kidney injury were risk factors for development of cardiovascular disease, disability and premature death.

"Physicians have been taught for decades to consider [acute kidney injury] and [chronic kidney disease] as separate,” Dr. Kimmel said in a prepared statement, “but our study shows that we have to approach the two diseases as interconnected.”

He added, "When people have chronic kidney disease, their doctors should be on the lookout for acute kidney injury. And when people have recovered from acute kidney injury, they should promptly follow up with their doctor and a kidney specialist to monitor their kidney function for long-term consequences related to progression of [chronic kidney disease]."

Robert Star, MD, director of the National Institute of Diabetes and Digestive and Kidney Disease and a study co-author, called for better communications between hospitals, doctors and kidney specialists.

“Hospitals need a system to consistently alert the patient’s primary care physician and a nephrologist so they can assess the patient’s kidney health periodically and ensure the highest standards of care," Dr. Star said in the press statement.

This study was published July 3 in the New England Journal of Medicine.

Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases.

A study co-author disclosed serving on steering committees for private companies as well as receiving fees for consultancy work.

Review Date: 
July 8, 2014
Last Updated:
July 8, 2014