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Titolo	The severity of acute kidney injury predicts progression to chronic kidney disease
Autore	Lakhmir S. Chawla1,2 , Richard L. Amdur3,4 , Susan Amodeo3,5 , Paul L. Kimmel1,6 and Carlos E. Palant1,3 - 1Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, District of Columbia, USA; 2 Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, Washington, District of Columbia, USA; 3 Research and Medical Service, Veterans Affairs Medical Center, Washington, District of Columbia, USA; 4 Departments of Psychiatry and Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA; 5 Decision Support Systems, Fiscal Service, Veterans Affairs Medical Center, Washington, District of Columbia, USA and6 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
Referenza	Kidney International 2011; doi:10.1038/ki.2011.42
Contenuto	Acute kidney injury (AKI) is associated with progression to advanced chronic kidney disease (CKD). We tested whether patients who survive AKI and are at higher risk for CKD progression can be identified during their hospital admission, thus providing opportunities to intervene. This was assessed in patients in the Department of Veterans Affairs Healthcare System hospitalized with a primary diagnosis indicating AKI (ICD9 codes 584.xx). In the exploratory phase, three multivariate prediction models for progression to stage 4 CKD were developed. In the confirmatory phase, the models were validated in 11,589 patients admitted for myocardial infarction or pneumonia during the same time frame that had RIFLE codes R, I, or F and complete data for all predictor variables. Of the 5351 patients in the AKI group, 728 entered stage 4 CKD after hospitalization. Models 1, 2, and 3 were all significant with ?c? statistics of 0.82, 0.81, and 0.77, respectively. In model validation, all three were highly significant when tested in the confirmatory patients, with moderate to large effect sizes and good predictive accuracy (?c? 0.81-0.82). Patients with AKI who required dialysis and then recovered were at especially high risk for progression to CKD. Hence, the severity of AKI is a robust predictor of progression to CKD.
Data	12.12.2011

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