Previously, I discussed a new predictive model for acute kidney injury (AKI). This month, I'd like to continue with the AKI theme and highlight a possibly new and concerning finding: acute kidney diseases and disorders without AKI (AKD without AKI). In JAMA Network Open, James and colleagues[1] suggest that a "subclinical" state of AKI exists and portends a worse prognosis than initially anticipated.
The authors contend that a substantial portion of patients transiently develop acute kidney damage that falls below the threshold for AKI (as defined by Kidney Disease Improving Global Outcomes [KDIGO]). Because these patients are not considered to have sustained any meaningful kidney damage, they are not monitored as closely as those who have full-blown AKI. The Canadian researchers hypothesize that these "normal" patients actually have a worse prognosis and should have closer nephrology follow-up than is typical.
To evaluate their suspicion, the authors performed a retrospective review of over 1 million patients in Alberta who had an estimated glomerular filtration rate > 15 mL/min/1.73 m2 and at least one serum creatininemeasurement in 2008. Patients were split into one of five categories: CKD, AKI, AKD without AKI, CKD plus AKD without AKI, or no kidney disease.
