Acute kidney injury: gateway to chronic kidney disease

This review examines the evidence linking acute kidney injury (AKI) with the risk of subsequently developing chronic kidney disease (CKD). The discussion focuses on subjects that recover from an episode of AKI, most of whom do not receive follow-up nephrology care. Many recent studies have shown a strong association between AKI and the risk of developing CKD. Preclinical models provide evidence for a causal link between AKI and CKD while also proposing some of the potential mechanisms for this progression. Large observational studies have begun to quantify the risk for CKD following AKI recovery and identify risk factors for the development of CKD. In summary, there is an association between AKI with incomplete recovery or lack of recovery and CKD. Multiple studies now suggest that even AKI with apparent full recovery confers an independent risk for later development of CKD. Severity of AKI, baseline CKD, and multiple episodes of AKI remain consistent risk factors for CKD after AKI. The proposed risk prediction models that have been developed require further refinement and validation. The identification of patients with AKI recovery who are at high risk for later CKD development remains an important clinical and research goal.