BEYOND RECOVERY : LONG TERM OUTCOMES AND RENAL PROGNOSIS AFTER ACUTE KIDNEY INJURY”

 

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BEYOND RECOVERY : LONG TERM OUTCOMES AND RENAL PROGNOSIS AFTER ACUTE KIDNEY INJURY”

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Pranavkumar
Bhat
Pranavkumar Bhat pranavkumarbhat@gmail.com INSTITUTE OF NEPHROUROLOGY BANGLORE NEPHROLOGY BANGLORE India *
Sreedhara C G drsreedharacg@gmail.com INSTITUTE OF NEPHROUROLOGY BANGLORE NEPHROLOGY BANGLORE India -
Kishan A drkishan81@gmail.com INSTITUTE OF NEPHROUROLOGY BANGLORE NEPHROLOGY BANGLORE India -
Mythri S pranavkumarbhat@gmail.com INSTITUTE OF NEPHROUROLOGY BANGLORE NEPHROLOGY BANGLORE India -
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Acute kidney injury (AKI) affects nearly one-fifth of hospitalized patients worldwide and remains a major determinant of subsequent renal outcomes. Even in patients demonstrating apparent short-term recovery, incomplete renal recovery significantly increases the risk of progression to chronic kidney disease (CKD) and, ultimately, end-stage renal disease (ESRD). Post-AKI follow-up care continues to be fragmented and inadequately integrated into long-term renal health strategies. This study aims to assess long-term outcomes and the risk of CKD progression following an episode of AKI, emphasizing the need for a structured framework for post-AKI care.

A prospective observational study was conducted in adults (≥18 years) with community- or hospital-acquired AKI. Patients with known CKD or obstructive uropathy were excluded. Participants were evaluated at baseline, 1, 3, 6 months, and 1 year post-discharge. The assessment included serum creatinine measurements, urine sediment analysis, pH, fasting urine osmolality, and creatinine-based indices to evaluate tubular function. Glomerular function was assessed through the urine protein-to-creatinine ratio (UPCR) at defined intervals

Data from 96 patients (mean age 57.5 years; 69.6% male) were analyzed. Hypertension (46.8%) and diabetes mellitus (20.8%) were the predominant comorbidities. The leading etiologies of AKI were acute gastroenteritis (29.2%), sepsis (20.8%), and tropical infections (8.3%). At discharge, complete recovery (CR), partial recovery (PR), and dialysis dependency rates were 8.1%, 61.7%, and 9.4%, respectively. Increasing age (OR 1.09, p < 0.0001) and higher serum creatinine at discharge (OR 2.48, p = 0.007) independently predicted poorer renal recovery. At 1 year, outcomes showed mortality at 2.08%, CR at 62.5%, PR at 35.4%, and dialysis dependence at 10.4%. Persistent tubular dysfunction (fasting urine osmolality <500 mOsm/kg) was observed in 18.7% of patients, and 12.9% had UPCR >0.5, indicating incomplete tubular and glomerular recovery in a subset of survivors.

OUTCOME-

TOTAL

PERCENTILE

HD DPENDENT AT DISCHARGE

28

29.16

HD DEPENDENT AT 6 MONTH

10

10.41

MORTALITY DURING FOLLOW UP

2

2.09

S. CREAT LESS THAN 1.2 AT 1 year

60

62.5

S. CREAT MORE THAN 1.2 AT 1 year

34

35.4

UPCR >0.5 AT 1 year

22

12.9

FASTING URINE OSMOLALITY AT 1 year LESS THAN 500

18

18.75

renal recovery following AKI is a dynamic process that extends beyond hospitalization. Comprehensive evaluation should ideally be performed no earlier than one year post-injury to fully characterize renal trajectory and identify individuals at risk for CKD progression. Structured post-AKI surveillance and intervention programs are essential to mitigate long-term kidney disease burden.

Kewords