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논문분류	춘계학술대회 초록집
제목	The Effect of Minor Episodes of Acute Kidney Injury on Progressive Renal Dysfunction in Early Stage of CKD Patients
저자	Eun Jung Cho, Myung Gyu Kim, Won-Yong Cho, Hyoung-Kyu Kim, Sang-Kyung Jo
출판정보	2013; 2013(1):
키워드	급성 신손상, 만성 신질환, 예후/Acute kidney injury, Chronic kidney disease, Prognosis
초록	Purpose: Several recent studies performed in in-hospital or intensive care unit settings revealed that dialysis requiring severe acute kidney injury (AKI) episode is a well-known risk factor for progression of chronic kidney disease (CKD) or increased long-term mortality. However, the impact of minor episodes of AKI in ambulatory, outpatient setting in patients with early stages of CKD has not been well studied. Methods: We retrospectively assembled a cohort of stable, 391 ambulatory patients with stage 2 or 3 CKD who had more than three values of serum creatinine and visited outpatient clinic longer than one year. Our primary outcome was a 15 ml/min/1.73m2 decline of estimated glomerular filtration rate (eGFR) and we analyzed the risk of CKD progression as a function of AKI episodes (increase of Scr ≥50% or ≥0.3 mg/dL). In addition, we also assessed the effect of eGFR variability defined as degree of deviation from the patient specific slope of eGFR on CKD progression. Results: Over a mean follow-up of 905 days, 100 (25.6%) patients had AKI episodes. Only one patient needed renal replacement therapy and most patients (74%) showed less than two fold increase of eGFR. Patients with AKI episodes were older and more likely to have diabetes or hypertension and lower baseline GFR. More patients were taking diuretics or beta blocker than patients without AKI episodes. Mean follow up period was similar in both groups. We observed no mortality in our cohort during the follow-up period. Significantly more patients with AKI episodes reached primary outcome than patients without AKI episodes [19 (19.0%) vs. 18 (6.2%), p=0.001]. In multivariate-adjusted Cox proportional hazard model, AKI episode and baseline eGFR were independent predictors of CKD progression defined as ≥15 ml/min/1.73m2 decline of eGFR (hazard ratio 5.515 for AKI vs. 1.039 for baseline GFR). However, eGFR variability was not found to be associated with faster progression of renal dysfunction. Conclusion: Even minor AKI episodes in stage 2 or 3, stable ambulatory CKD patients are thought to be still a powerful risk factor for progression of CKD and a multi-sided approach to develop tools for prevention, risk stratification or early detection, should be continued to improve the ultimate prognosis.
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