Acute kidney injury and chronic kidney disease are interconnected, say GW researchers

For more than 40 years, physicians have treated diminished kidney function as two distinct syndromes: acute kidney injury (AKI) and chronic kidney disease (CKD). However, recent epidemiologic and mechanistic studies suggest the two syndromes are not distinct entities, but interconnected. Published today in The New England Journal of Medicine, George Washington University (GW) researchers call for greater follow-up care of patients with AKI, who often present with CKD later in life, and vice versa.

"Our teaching has been wrong and the approach to the patient with decreased renal function has been too limited. Every doctor who sees patients with CKD should think about AKI and every doctor who sees a patient with AKI, should think about CKD as a possible sequel of AKI," said Paul Kimmel, M.D., clinical professor of medicine at the GW School of Medicine and Health Sciences (SMHS). "Our review article is written for surgeons, for general internists, for pediatricians, for orthopedists —anyone who takes care of patients, because AKI is such a common problem."

AKI, previously called acute renal failure, is often the result of crush injury, a side effect of drugs, or severe infection, and defined as a sudden increase in the serum creatinine concentration and decreased urine output. After recovery, patients receive little to no follow-up care by nephrologists. CKD often lasts a long time, changes slowly, and culminates in dialysis or renal transplantation.

In the article, Kimmel and his co-author, Lakhmir Chawla, M.D., associate professor of anesthesiology and critical care medicine at SMHS and physician at the VA Medical Center, outline several findings suggesting that AKI not only is directly linked to the progression of CKD, but can actually cause CKD. Conversely, the presence of CKD is an important risk factor for the development of AKI. Both AKI and CKD have bad outcomes — most particularly, cardiovascular disease.

"We need to start with a deeper sense of awareness for physicians, improving the follow-up care of patients who suffer from AKI, which is currently not done very well," said Chawla. "It's not like someone who has a heart attack, where that person will be seen by a cardiologist a couple weeks after they're discharged. A very small percentage of patients who suffer from AKI are seen by a nephrologist after the initial events."