Acute and Chronic Kidney Diseases May Be Better Approached As Combined Syndrome

Paul Kimmel, M.D. Division of Kidney, Urologic and Hematologic Diseases National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health Professor Division of Renal Diseases and Hypertension The George Washington University MedicalResearch.com Interview with:
Paul Kimmel, M.D.
Division of Kidney, Urologic and Hematologic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health
Professor Division of Renal Diseases and Hypertension
The George Washington University

Medical Research: What are the main findings of the review?

Dr. Kimmel: AKI (Acute Kidney Injury) and CKD (Chronic Kidney Disease), two syndromes approached separately in medical school curricula as well as in the clinical arena are inextricably intertwined. They should be taught as a combined entity, culminating in progressive loss of renal function necessitating renal replacement therapy (dialysis or transplantation).

The two syndromes increase risk for cardiovascular disease and diminished quality of life as well. Preventive and therapeutic strategies should be directed at the combined entity.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kimmel: We know little about the outcomes of patients without preexisting kidney disease who develop AKI. Patients with Acute Kidney Injury, in the presence or absence of CKD, need careful follow-up by physicians. Pediatric populations and the elderly with AKI are especially important groups to evaluate.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kimmel: We know little about the treatment of patients with AKI and CKD after they are discharged from the hospital. In particular, we do not know if therapies derived in patients with CKD will be helpful in patients with AKI and CKD. Future research should address therapeutic options in this patient population with randomized controlled trials.

Citation:

Acute Kidney Injury and Chronic Kidney Disease as Interconnected Syndromes

Lakhmir S. Chawla, M.D., Paul W. Eggers, Ph.D., Robert A. Star, M.D., and Paul L. Kimmel, M.D.

N Engl J Med 2014; 371:58-66July 3, 2014DOI: 10.1056/NEJMra1214243