Acute kidney injury as a risk and progression factor for chronic kidney injury

Acute kidney injury is common in hospitalized patients and is associated with significant in-hospital morbidity and mortality. However, hospital-acquired acute kidney injury is neither a harmless complication of severe underlying diseases nor a life threatening short-term illness. Posthospital discharge follow-up of patients highlights that survivors of acute kidney injury may develop serious long-term sequelae. Long-term mortality is greater in those patients who survived acute kidney injury when compared with critically or non-critically ill patients without acute kidney injury. Among survivors of acute kidney injury at long-term follow-up approximately 12.5% may be dialysis dependent and 19-31% may have chronic kidney disease. The incidence of end-stage renal disease secondary to acute kidney injury will likely continue to increase with more elderly patients treated in Intensive Care Units, with a higher burden of extra renal and renal comorbid diseases. Nephrologists should recognize acute kidney injury as an underestimated cause of chronic kidney disease and patients who survive with incomplete recovery should be followed closely for new chronic kidney disease or progression of pre-existing chronic kidney disease. Non-recovery or re-need for dialysis are not only important determinants of long-term health status, quality of life and mortality of these patients, but add also a burden to health resources.