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Harm! foul! How acute kidney injury SHReDDs patient futures

Jessica F Hebert1, Yoshio Funahashi1, Michael P Hutchens1,2

  • 1Department of Anesthesiology & Perioperative Medicine, Oregon Health and Science University.

Current Opinion in Nephrology and Hypertension
|January 23, 2023
PubMed
Abstract

Insights

Acute kidney injury (AKI) can lead to chronic kidney disease (CKD) and other organ damage, including stroke, hypertension, and dementia. Early recognition of these long-term complications is crucial for patient care.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Neurology

Background:

  • The transition from acute kidney injury (AKI) to chronic kidney disease (CKD) is well-established.
  • Emerging evidence suggests AKI also increases the risk of developing diseases in other organ systems.
  • Understanding these extra-renal sequelae is critical for comprehensive patient management post-AKI.

Approach:

  • Review of clinical data and preclinical studies investigating long-term outcomes after AKI.
  • Analysis of hazard ratios for various post-AKI complications, including stroke, hypertension, reproductive risk, dementia, and death (SHReDD).
  • Exploration of kidney-centric mechanisms, such as sodium and volume regulation, and the renin-angiotensin system, implicated in extra-renal disease development.

Key Points:

  • Patients diagnosed with AKI face an increased risk of SHReDD complications within 6 months to 3 years.
  • The adjusted hazard ratios for these SHReDD sequelae are comparable to those observed for AKI-CKD progression (ranging from 1.2 to 3.0).
  • Mechanistic studies implicate renal regulatory systems in driving long-term extra-renal pathologies.

Conclusions:

  • Further clinical and mechanistic research is needed to fully elucidate the links between AKI and other organ system diseases.
  • Expanding post-AKI patient screening and follow-up protocols to include SHReDD complications can enhance clinical utility and patient outcomes.

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