Recent advances in acute kidney injury epidemiology

Abstract

Expanding rates of acute kidney injury (AKI) coupled with increasing awareness of its short-term and long-term sequelae have focused efforts to identify patients at risk for this disease and its complications. This review details the recent attempts to identify novel risk factors for AKI, describes further refinements in the diagnostic and prognostic approach using biological markers of injury, and highlights the features of AKI that independently predict poor long-term outcomes. The presence of proteinuria predicts the development of AKI independently of estimated glomerular filtration rate. Initial results from a large prospective study of AKI biomarkers in cardiac surgery indicate lower agreement with serum creatinine as an AKI standard than observed in early studies. AKI severity and duration are important predictors of chronic kidney disease and long-term mortality. A minority of patients surviving AKI with decreased kidney function is seen by a nephrologist. Although the pathophysiologic link is unclear, proteinuria is an easily measurable risk factor for AKI worth considering before anticipated procedures or medication exposures carrying nephrologic risk. Investigation extending beyond agreement with serum creatinine is needed to fully understand the diagnostic and prognostic value of AKI biomarkers. Severity and duration are components of AKI that can help risk-stratify survivors in need of monitoring or nephrology referral.