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Predicting risk of recurrent acute kidney injury: a systematic review

Predicting risk of recurrent acute kidney injury: a systematic review
Predicting risk of recurrent acute kidney injury: a systematic review
Background: although the epidemiology of acute kidney injury (AKI) has been well described, less is known about recurrent AKI (r-AKI). We undertook a systematic review to identify incidence, risk factors, and outcomes of r-AKI.

Methods: Medline, Embase, CINAHL, Cochrane, Web of Science were searched, from inception to December 2017, for quantitative studies on adults with AKI, where follow-up included reporting of r-AKI. Two reviewers independently identified studies and assessed study quality.

Summary: from 2824 citations, 10 cohort studies met inclusion criteria (total patients n=538,667). There were 2 distinct set of studies; Four studies assessed r-AKI within the same hospital admission (most were intensive care unit (ICU) patients) and six studies assessed post-discharge r-AKI. The median percentage of people developing r-AKI within the same hospital admission was 23.4% (IQR: 20.3% - 27.2%) and post-discharge r-AKI was 31.3% (IQR: 26.4% - 33.7%). A higher Acute Physiology and Chronic Health Evaluation (APACHE) score was associated with increased risk of r-AKI within the same hospital admission in ICU patients. Cardiovascular disease and AKI severity were associated with increased risk of post-discharge r-AKI. R-AKI (within same admission and post-discharge) was associated with worse survival. It was not possible to pool results due to methodological differences across studies, such as varying definitions for AKI and r-AKI, varying length of follow up and effect measures.

Key messages: more representative population based studies with robust assessment of predictors and consensus definition of r-AKI are needed to identify risk factors and develop risk stratification tools to reduce recurrence and improve outcomes.
1660-8151
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Glidewell, Liz
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Blakeman, Thomas
8b245cf7-a836-46a5-adae-527bf17b10fa
Lewington, Andrew
6d8add3b-4b8d-4a6b-b1a4-f8f7b94a1bba
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Glidewell, Liz
a9babf5f-7798-4db5-8a4e-f588510c087f
Blakeman, Thomas
8b245cf7-a836-46a5-adae-527bf17b10fa
Lewington, Andrew
6d8add3b-4b8d-4a6b-b1a4-f8f7b94a1bba
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Hounkpatin, Hilda, Fraser, Simon, Glidewell, Liz, Blakeman, Thomas, Lewington, Andrew and Roderick, Paul (2019) Predicting risk of recurrent acute kidney injury: a systematic review. Nephron Clinical Practice. (doi:10.1159/000497385).

Record type: Article

Abstract

Background: although the epidemiology of acute kidney injury (AKI) has been well described, less is known about recurrent AKI (r-AKI). We undertook a systematic review to identify incidence, risk factors, and outcomes of r-AKI.

Methods: Medline, Embase, CINAHL, Cochrane, Web of Science were searched, from inception to December 2017, for quantitative studies on adults with AKI, where follow-up included reporting of r-AKI. Two reviewers independently identified studies and assessed study quality.

Summary: from 2824 citations, 10 cohort studies met inclusion criteria (total patients n=538,667). There were 2 distinct set of studies; Four studies assessed r-AKI within the same hospital admission (most were intensive care unit (ICU) patients) and six studies assessed post-discharge r-AKI. The median percentage of people developing r-AKI within the same hospital admission was 23.4% (IQR: 20.3% - 27.2%) and post-discharge r-AKI was 31.3% (IQR: 26.4% - 33.7%). A higher Acute Physiology and Chronic Health Evaluation (APACHE) score was associated with increased risk of r-AKI within the same hospital admission in ICU patients. Cardiovascular disease and AKI severity were associated with increased risk of post-discharge r-AKI. R-AKI (within same admission and post-discharge) was associated with worse survival. It was not possible to pool results due to methodological differences across studies, such as varying definitions for AKI and r-AKI, varying length of follow up and effect measures.

Key messages: more representative population based studies with robust assessment of predictors and consensus definition of r-AKI are needed to identify risk factors and develop risk stratification tools to reduce recurrence and improve outcomes.

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Predicting risk of recurrent acute kidney injury Jan 19 - Accepted Manuscript
Restricted to Repository staff only until 21 March 2020.
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Accepted/In Press date: 30 January 2019
e-pub ahead of print date: 21 March 2019

Identifiers

Local EPrints ID: 428172
URI: https://eprints.soton.ac.uk/id/eprint/428172
ISSN: 1660-8151
PURE UUID: c5ba75b2-f7bb-44af-85e5-bb18b9a93286
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 13 Feb 2019 17:30
Last modified: 26 Apr 2019 00:37

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Contributors

Author: Simon Fraser ORCID iD
Author: Liz Glidewell
Author: Thomas Blakeman
Author: Andrew Lewington
Author: Paul Roderick ORCID iD

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