New Insights into Acute-on-Chronic Kidney Disease in Nephrology Patients: The CKD-REIN Study.

Aghilès Hamroun (1) , Luc Frimat (2) , Maurice Laville (3) , Marie Metzger (4, 5) , Christian Combe (6, 7) , Denis Fouque (3, 8) , Christian Jacquelinet (9, 4) , Carole Ayav (10) , Sophie Liabeuf (11, 12) , Céline Lange (4, 9) , Yves-Edouard Herpe (13, 11) , Jarcy Zee (14) , François Glowacki (1) , Ziad A. Massy (15, 4) , Bruce Robinson (16) , Bénédicte Stengel (17, 4, 5, 18)

1 Service de Néphrologie et Transplantation rénale [CHRU-lille]
2 Service de Néphrologie [CHRU Nancy]
3 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
4 CESP - Centre de recherche en épidémiologie et santé des populations
5 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
6 BIOTIS - Bioingénierie tissulaire
7 Service de Néphrologie-transplantation-dialyse [Bordeaux]
8 HCL - Hospices Civils de Lyon
9 Agence de la biomédecine [Saint-Denis la Plaine]
10 CIC-EC - Centre d'investigation clinique - Epidémiologie clinique [Nancy]
11 CHU Amiens-Picardie
12 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
13 Biobanque de Picardie [CHU Amiens - Hôpital Sud]
14 University of Michigan [Ann Arbor]
15 Hôpital Ambroise Paré [AP-HP]
16 Arbor Research Collaborative for Health
17 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
18 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]

BACKGROUND: Acute-on-chronic kidney disease (ACKD) is poorly understood and often overlooked. We studied its incidence, circumstances, determinants and outcomes in patients with CKD. METHODS: We used the Kidney Disease: Improving Global Outcomes criteria to identify all-stage acute kidney injury (AKI) events in 3033 nephrology outpatients with CKD Stages 3-5 participating in the CKD-Renal Epidemiology and Information Network cohort study (2013-20), and cause-specific Cox models to estimate hazard ratios [HRs; 95% confidence intervals (CIs)] of AKI-associated risk factors. RESULTS: At baseline, 22% of the patients [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] had a history of AKI. Over a 3-year follow-up, 443 had at least one AKI event: 27% were Stage 2 or 3 and 11% required dialysis; 74% involved hospitalization including 47% acquired as hospital inpatients; and a third were not reported in hospital discharge reports. Incidence rates were 10.1 and 4.8/100 person-years in patients with and without an AKI history, respectively. In 2375 patients without this history, male sex, diabetes, cardiovascular disease, cirrhosis, several drugs, low eGFR and serum albumin levels were significantly associated with a higher risk of AKI, as were low birth weight (<2500 g) (adjusted HR 1.98; 95% CI 1.35-2.91) and haemoglobin level (HR 1.21; 1.12-1.32 per 1 g/dL decrease). Within 1 year, only 63% of the patients had recovered their previous kidney function, 13.7% had started kidney replacement therapy and 12.7% had died. CONCLUSIONS: The study highlights the high rate of hospital-acquired AKI events in patients with CKD, and their underreporting at hospital discharge. It also reveals low birth weight and anaemia as possible new risk factors in CKD patients.

Mots clés: *Acute Kidney Injury/epidemiology/etiology/therapy; *Kidney Failure; Chronic/therapy; *Nephrology; *Renal Insufficiency; Chronic/complications/epidemiology/therapy; acute kidney injury; acute-on-chronic kidney disease; Aged; chronic kidney disease; Cohort Studies; Female; Glomerular Filtration Rate; Humans; kidney failure; Male; Renal Dialysis; renal recovery; Risk Factors

Domaines: Médecine humaine et pathologie

Aghilès Hamroun, Luc Frimat, Maurice Laville, Marie Metzger, Christian Combe, et al.. New Insights into Acute-on-Chronic Kidney Disease in Nephrology Patients: The CKD-REIN Study.. Nephrology Dialysis Transplantation, 2022, 37 (9), pp.1700--1709. ⟨10.1093/ndt/gfab249⟩. ⟨hal-03760907⟩