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Proteinuria After Inpatient Acute Kidney Injury Tied to Later Risk

Higher post-acute kidney injury urine albumin-to-creatinine ratio linked to kidney disease progression

TUESDAY, Jan. 28, 2020 (HealthDay News) — Urine albumin-to-creatinine ratio (ACR) measured after acute kidney injury (AKI) predicts subsequent loss of renal function, according to a study published online Jan. 27 in JAMA Internal Medicine.

Chi-yuan Hsu, M.D., from the University of California School of Medicine in San Francisco, and colleagues conducted a multicenter study involving 1,538 patients enrolled three months after hospital discharge to examine the association between post-AKI proteinuria and risk for subsequent loss of renal function. A total of 769 participants had AKI during hospitalization.

The researchers found that 9 percent of participants had kidney disease progression after a median follow-up of 4.7 years. There was an association for higher post-AKI urine ACR level with elevated risk for kidney disease progression (hazard ratio, 1.53 for each doubling); urine ACR strongly discriminated future kidney disease progression (C statistic, 0.82). Urine ACR had a stronger performance in those who had had AKI compared with those who had not (C statistic, 0.70). Better discrimination for predicting kidney disease progression after hospital discharge was seen with a comprehensive model of clinical risk factors, including ACR among those who had had AKI versus those who had not (C statistic, 0.85 versus 0.76).

“Our results suggest there should be more widespread and routine quantification of proteinuria after hospitalized AKI, perhaps similar to how patients with diabetes mellitus undergo screening for proteinuria,” the authors write. “This would represent a substantial change from current clinical practice.”

Several authors disclosed financial ties to the biopharmaceutical and medical technology industries; one author is a coinventor on a patent.

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