Year: 2017
Type: editorial
Abstract: Acute kidney injury (AKI) is a major contributor to morbidity and mortality in hospitalized patients across the world. 1 Affecting up to 20% of all admissions (depending on which definition of AKI is used), 2 AKI is the most common reason for new-inpatient nephrology consultation.Recent data suggest that AKI incidence has risen rapidly, by up to 10% per year.3,4 AKI is associated with a variety of serious short-and longterm complications.Approximately 33% to 60% of critically ill patients who develop dialysis-requiring AKI do not survive to hospital discharge, and mortality associated with dialysis-requiring AKI is greater than that associated with other serious conditions such as myocardial infarction or acute respiratory distress syndrome.5 Even relatively mild AKI in the acute inpatient setting appears to be an independent risk factor for mortality.6 For several decades, many physicians believed that AKI was a self-limited process followed by complete recovery of renal function to pre-AKI levels among survivors.(Numerous trainees have been taught some variant of the old adage: "If the patients survive, so will their kidneys.")But studies linking AKI with the development of new-onset chronic kidney disease (CKD) or the accelerated progression of pre-existing CKD have changed this view.7 One important reason the long-term impact of AKI hasn't been appreciated is that, traditionally, clinical studies of AKI examined inhospital outcomes such as short-term mortality and resource usage and did not consider what transpired months to years after discharge.More recently, epidemiologic studies linking inpatient events with outpatient outcomes have filled this knowledge gap.8 Contemporary animal models of AKI have shed light on potential mechanisms of maladaptive repair after AKI, characterized by fibrosis, vascular rarefaction, tubular loss, glomerulosclerosis, and chronic interstitial inflammation, all of which result in renal function decline.So over the last decade there has been a paradigm shift in how we think about AKI and CKD.Rather than distinct entities, AKI and CKD are now viewed as interconnected syndromes since AKI is a risk factor for CKD progression and CKD is a risk factor for new episodes of AKI. 9 Two studies published in this issue of the Journal of Hospital Medicine augment our understanding of AKI and its clin-
Source: Journal of Hospital Medicine
DOI: 10.12788/jhm.2691
Authors: Benjamin J. Lee, Chi‐yuan Hsu
Institution: University of California, San Francisco
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2585828625