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THE ROLE OF ACUTE KIDNEY INJURY IN CHRONIC KIDNEY DISEASE #MMPMID27475659
Hsu RK; Hsu Cy
Semin Nephrol 2016[Jul]; 36 (4): 283-92 PMID27475659show ga
There is increasing recognition that acute kidney injury (AKI) and chronic kidney disease (CKD) are closely linked and likely promote one another. Underlying CKD is now recognized as a clear risk factor for AKI, as both decreased glomerular filtration rate (GFR) and increased proteinuria have each been shown to be strongly associated with AKI. A growing body of literature also provides evidence that AKI accelerates the progression of CKD. Individuals who suffered dialysis-requiring AKI are particularly vulnerable to worse long-term renal outcomes, including end-stage renal disease (ESRD). The association between AKI and subsequent renal function decline is amplified by pre-existing severity of CKD, higher stage AKI, and cumulative number of AKI episodes. However, residual confounding and ascertainment bias may partly explain the epidemiologic association between AKI and CKD in observational studies. As the number of AKI survivors increases, we need to better understand other clinically important outcomes after AKI, identify those at highest risk for the most adverse sequelae, and develop strategies to optimize their care.