12 Nov An Episode of Acute Kidney Injury Increases Risk and Rate of End Stage Renal Failure
Dr. Thakar
MedicalResearch.com Interview with:
Charuhas Thakar, MD
Director, Division of Nephrology and Hypertension Professor of Medicine
University of Cincinnati
Medical Research: What is the background for this study? What are the main findings?
“Diabetes is the major contributor to the growing burden of end-stage renal disease,” says Charuhas Thakar, MD, professor and director of the Division of Nephrology and Hypertension at the UC College of Medicine.
“Acute kidney injury is a common problem among diabetic patients who require admissions to hospitals. Approximately one-third of patients who develop AKI also have diabetes mellitus.”
Dr. Thakar along with a team of researchers have looked at a cohort of about 3,700 patients with Type 2 diabetes longitudinally followed for a five-year period to determine AKI’s impact.
AKI is a rapid loss of kidney function, which is common in hospitalized patients.
It has many causes that include low blood volume, exposure to substances or interventions harmful to the kidney and
obstruction of the urinary tract.
Medical Research: What should clinicians and patients take away from your report?
“The average age of a diabetic patient who starts dialysis in the US is about 67 years old,” says Dr. Thakar.
“In a simplified way, if someone starts with a 100 percent renal function and has diabetes,
the study finds that the overall rate of loss of renal function is approximately 2.5 percent per year. However, those who suffered AKI
lost renal function at a rate of about 5 percent per year.
“This translates into a profound impact for the patient,” says Thakar.
“This would put the
patient closer to dialysis within half as much time compared to if they had not experienced AKI.”
Thakar’s research also found that the rate of loss of renal function accelerates in the
period after AKI compared to the period before the diagnosis. “In those subjects with available data, we found that the pre-AKI rate of loss or renal function was 2.9 ml/min/year where as it went to 6.7 ml/min/year in the period following AKI,” says Thakar.
“This is the closest evidence yet, that an AKI episode
not only increases the risk of chronic kidney disease,
but also accelerates the rate of loss of renal function.”
Medical Research: What recommendations do you have for future research as a result of this study?
“The implications of this finding are very important to both patients
and the health care system,”
“From a patient’s standpoint, there is an imminent need to develop novel strategies to reduce
the progression to end stage renal disease in diabetic patients,
particularly those with AKI.
Also, diabetic patients who develop AKI in the hospital need more careful monitoring after they are released from the hospital.
“As a health care system, we need to identify patients who are
likely to progress faster to
end-stage renal disease,” says Thakar.
“Transition to end-stage renal disease is associated with high morbidity and costs,
and requires careful planning and multi-disciplinary care.
We need to be pro-active in our approaches to plan end-stage renal disease care in diabetic patients who have experienced AKI.”
Dr. Thakar says the study has limitations.
“This is an observational study from a single center and
could have potential unmeasured confounders,” he explains.
Citation:
Abstract Presented at the 2015 ASN
Acute Kidney Injury Episodes Accelerates Rate of Loss of Renal Function in Diabetes Mellitus Charuhas V. Thakar,1,2 Anthony C. Leonard,1,3 Karthikeyan Meganathan,1,3 V. Shane Pankratz.4 1Internal Medicine, Univ of Cincinnati, Cincinnati, OH; 2Medicine, Cincinnati VAMC, Cincinnati, OH; 3Family Medicine, Univ of Cincinnati, Cincinnati, OH; 4Internal Medicine, Univ of New Mexico, Albuquerque, NM.
Charuhas Thakar, MD (2015). An Episode of Acute Kidney Injury Increases Risk and Rate of End Stage Renal Failure
Last Updated on November 12, 2015 by Marie Benz MD FAAD