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In-Hospital Kidney Injury requiring Dialysis
linked to risk of Chronic Dialysis
Newswise — Hospitalized patients who
experience acute kidney problems that
require dialysis are at increased risk of
receiving chronic dialysis once discharged,
but do not have an increased risk of death,
according to a study in the September 16
issue of JAMA.
“Acute kidney injury, which leads to a
sudden decline in kidney function, is a
common and serious complication of
hospitalization in the adult population.
patients with severe acute kidney injury
require initiation of hemodialysis or
hemofiltration [dialysis], and their
in-hospital mortality rate ranges from 45
percent to 70 percent. Among those who
survive, as many as 15 percent require
dialysis at the time of discharge,”
according to background information in the
The authors note that little is known about
the long-term outcomes of patients with an
acute kidney injury that requires
in-hospital dialysis, especially once they
leave the hospital and recover enough kidney
function to be free of dialysis in the short
Ron Wald, M.D.C.M., M.P.H., F.R.C.P.C., of
St Michael’s Hospital, Toronto, and the
University of Toronto, and colleagues
evaluated the long-term risk of chronic
dialysis and death among hospitalized
patients in Ontario, Canada, who sustained
an acute kidney injury while hospitalized,
required dialysis and survived free of
dialysis for at least 30 days after
discharge. These individuals (n = 3,769)
were matched with patients without acute
kidney injury or dialysis during their
hospitalization (n = 13,598).
Patients were followed up until March 2007.
The average age of the enrolled participants
was 62 years, and approximately 40 percent
After a median (midpoint) follow-up of 3
years, the researchers “found that survivors
of a hospitalization complicated by acute
kidney injury requiring dialysis were
approximately 3 times more likely to require
chronic dialysis compared with those without
acute kidney injury.
However, no difference was observed between
these groups for long-term mortality.”
“Our findings expand on prior knowledge to
provide clinicians with new information
about the long-term effect of acute kidney
injury that arises during a hospitalization.
if affected patients survive to hospital
discharge, then they remain at high risk of
needing dialysis over the next 3 to 5 years.
Patients who survive a hospitalization
complicated by acute kidney injury requiring
dialysis may benefit from specialized care
to address complications of chronic kidney
disease, and also from concerted efforts to
prevent progression to chronic dialysis.
At the same time, their high mortality rate
is similar to hospitalized patients without
acute kidney injury or need for dialysis.
an episode of acute kidney injury requiring
in-hospital dialysis may not be an
independent contributing factor to long-term
survival,” the authors conclude.