AKI and Long-Term Risk for Cardiovascular Events and Mortality

• Published in: Journal of the American Society of Nephrology Vol. 28; no. 1; pp. 377 - 387
• Main Authors: Odutayo, Ayodele, Wong, Christopher X., Farkouh, Michael, Altman, Douglas G., Hopewell, Sally, Emdin, Connor A., Hunn, Benjamin H.
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.01.2017
• Subjects: Acute Kidney Injury - complications; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Humans; Meta-Analysis; Risk Factors; Time Factors; Ischemic Heart Disease; cardiovascular disease; congestive heart failure; Stroke; acute renal failure
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2016010105

AKI associates with increased long-term risk of mortality, but the prognostic significance of AKI in terms of long-term cardiovascular disease remains unconfirmed. We conducted a systematic review and meta-analysis to assess whether AKI associates with long-term cardiovascular disease. We included cohort studies that examined adults with and without AKI and reported a multivariable-adjusted relative risk (RR) for the association between AKI and cardiovascular mortality, major cardiovascular events, and disease-specific events: congestive heart failure, acute myocardial infarction, and stroke. Twenty-five studies involving 254,408 adults (55,150 with AKI) were included. AKI associated with an 86% and a 38% increased risk of cardiovascular mortality and major cardiovascular events, respectively ([RR 1.86; 95% confidence interval (95% CI), 1.72 to 2.01] and [RR 1.38; 95% CI, 1.23 to 1.55], respectively). For disease-specific events, AKI associated with a 58% increased risk of heart failure (RR 1.58; 95% CI, 1.46 to 1.72) and a 40% increased risk of acute myocardial infarction (RR 1.40; 95% CI, 1.23 to 1.59). The elevated risk of heart failure and acute myocardial infarction persisted in subgroup analyses on the basis of AKI severity and the proportion of adults with baseline ischemic heart disease. Finally, AKI was associated with a 15% increased risk of stroke (RR 1.15; 95% CI, 1.03 to 1.28). In conclusion, AKI associates with an elevated risk of cardiovascular mortality and major cardiovascular events, particularly heart failure and acute myocardial infarction.