The risk of developing chronic kidney disease rises with multiple episodes of acute kidney injury during hospital stays for patients with diabetes, a recent University of Cincinnati and Cincinnati Department of Veterans Affairs (VA) Medical Center study suggests.
"Diabetes mellitus is the single largest contributor to the growing prevalence of chronic kidney disease," says Charuhas Thakar, MD, associate professor of medicine at UC and chief of nephrology at the Cincinnati VA, Science Daily reports. "Diabetic patients can experience multiple hospitalizations due to variety of medical problems in the long-term.
"Given this background, we wanted to study the effect of multiple episodes of acute kidney injury on the risk of progressive kidney disease in a diabetic patient. We also wanted to establish that the link is independent of other known risk factors of diabetic kidney failure such as high blood pressure or presence of protein in the urine."
Common in hospitalized patients, acute kidney injury is a rapid loss of kidney function, according to Science Daily. Its many causes include include low blood volume, exposure to substances or interventions harmful to the kidney and obstruction of the urinary tract.
Researchers conducted follow-up care for 4,082 patients with diabetes mellitus from a VA health care system over 10 years (1999-2008), Science Daily reports. They noted the effect of the first injury episode and up to three additional episodes as time-dependent risk factors of Stage IV chronic kidney disease (pre-dialysis stage).
Other variables included demographics, baseline level of renal function and other major risk factors that could lead to kidney failure in diabetes such as presence of hypertension and proteinuria, or excess protein in the urine.
"Of the 3,679 patients who were eligible to participate, over half of the diabetics required at least one hospitalization during the follow-up period," Thakar says, as reported by Science Daily. "Once hospitalized, 30 percent of them experienced at least one episode of acute kidney injury during hospitalization. Of those patients who developed injury and survived, 30 percent developed two or more episodes.
"These findings clearly show that in diabetic patients, who may face the prospect of kidney failure or dialysis, episodes of acute kidney injury facilitate that risk," Thakar says, as reported by Science Daily. "We need effective strategies to prevent or treat acute kidney injury in hospitalized patients as one of the ways to curb the growing burden of end stage kidney disease in diabetics."
The study is published in the November issue of the Clinical Journal of the American Society of Nephrology.
