Rapid Occurrence of Chronic Kidney Disease in Patients Experiencing Reversible Acute Kidney Injury after Cardiac Surgery

David Legouis (1) , Pierre Galichon (2, 3) , Aurélien Bataille (2) , Sylvie Chevret (4) , Sophie Provenchère (5) , Anne Boutten (6) , Dimitrios Buklas (7) , Jean-Luc Fellahi (8) , Jean-Luc Hanouz (1) , Alexandre Hertig (3, 2)

1 Service d'Anesthésie - Réanimation Chirurgicale [CHU Caen]
2 Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation
3 CHU Tenon [AP-HP]
4 Service de biostatistiques et information médicale [Saint-Louis]
5 Service d'anesthésie [CHU Bichat]
6 Service de biochimie [CHU Bichat]
7 Service de chirurgie cardiaque [CHU Caen]
8 Hôpital Louis Pradel [CHU - HCL]

Background: There is recent evidence to show that patients suffering from acute kidney injury are at increased risk of devel-oping chronic kidney disease despite the fact that surviving tubular epithelial cells have the capacity to fully regenerate renal tubules and restore renal function within days or weeks. The aim of the study was to investigate the impact of acute kidney injury on de novo chronic kidney disease. Methods: The authors conducted a retrospective population-based cohort study of patients initially free from chronic kidney disease who were scheduled for elective cardiac surgery with cardiopulmonary bypass and who developed an episode of acute kidney injury from which they recovered. The study was conducted at two French university hospitals between 2005 and 2015. These individuals were matched with patients without acute kidney injury according to a propensity score for develop-ing acute kidney injury. Results: Among the 4,791 patients meeting the authors’ inclusion criteria, 1,375 (29%) developed acute kidney injury and 685 fully recovered. Propensity score matching was used to balance the distribution of covariates between acute kidney injury and non- acute kidney injury control patients. Matching was possible for 597 cases. During follow-up, 34 (5.7%) had reached a diagnosis of chronic kidney disease as opposed to 17 (2.8%) in the control population (hazard ratio, 2.3; bootstrapping 95% CI, 1.9 to 2.6). Conclusions: The authors’ data consolidate the recent paradigm shift, reporting acute kidney injury asa strong risk factor for the rapid development of chronic kidney disease.

Domaines: Urologie et Néphrologie; Chirurgie

David Legouis, Pierre Galichon, Aurélien Bataille, Sylvie Chevret, Sophie Provenchère, et al.. Rapid Occurrence of Chronic Kidney Disease in Patients Experiencing Reversible Acute Kidney Injury after Cardiac Surgery. Anesthesiology, 2016, 126 (1), pp.39-46. ⟨10.1097/ALN.0000000000001400⟩. ⟨hal-01398136⟩