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Ron Wald, MDCM, MPH, FRCPC; Robert R. Quinn, MD, FRCPC; Jin Luo, MD; Ping Li, PhD; Damon C. Scales, MD, PhD, FRCPC; Muhammad M. Mamdani, PharmD, MPH; Joel G. Ray, MD, MSc, FRCPC; for the University of Toronto Acute Kidney Injury Research Group

JAMA. 2009;302(11):1179-1185.

Context  Severe acute kidney injury among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who survive to hospital discharge.

Objective  To assess the risk of chronic dialysis and all-cause mortality in individuals who experience an episode of acute kidney injury requiring dialysis.

Design, Setting, and Participants  We conducted a population-based cohort study of all adult patients in Ontario, Canada, with acute kidney injury who required in-hospital dialysis and survived free of dialysis for at least 30 days after discharge between July 1, 1996, and December 31, 2006. These individuals were matched with patients without acute kidney injury or dialysis during their index hospitalization. Matching was by age plus or minus 5 years, sex, history of chronic kidney disease, receipt of mechanical ventilation during the index hospitalization, and a propensity score for developing acute kidney injury requiring dialysis. Patients were followed up until March 31, 2007.

Main Outcome Measures  The primary end point was the need for chronic dialysis and the secondary outcome was all-cause mortality.

Results  We identified 3769 adults with acute kidney injury requiring in-hospital dialysis and 13 598 matched controls. The mean age was 62 years and median follow-up was 3 years. The incidence rate of chronic dialysis was 2.63 per 100 person-years among individuals with acute kidney injury requiring dialysis, and 0.91 per 100 person-years among control participants (adjusted hazard ratio, 3.23; 95% confidence interval, 2.70-3.86). All-cause mortality rates were 10.10 and 10.85 per 100 person-years, respectively (adjusted hazard ratio, 0.95; 95% confidence interval, 0.89-1.02).

Conclusions  Acute kidney injury necessitating in-hospital dialysis was associated with an increased risk of chronic dialysis but not all-cause mortality.

Author Affiliations: Divisions of Nephrology (Dr Wald) and General Internal Medicine (Dr Ray), St Michael's Hospital; The Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital (Drs Wald, Mamdani, and Ray); Department of Medicine, University of Toronto (Drs Wald, Scales, Mamdani, and Ray); Division of Nephrology (Dr Quinn) and Department of Critical Care Medicine (Dr Scales), Sunnybrook Health Sciences Centre; and the Institute for Clinical Evaluative Sciences (Drs Luo, Li, Scales, Mamdani, and Ray), all in Toronto, Ontario, Canada, and Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia (Dr Mamdani).

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