Kidney injury raises chances of ESRD

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Kidney stones (white) may be caused by dehydration, infection, or metabolic disorders.
Kidney stones (white) may be caused by dehydration, infection, or metabolic disorders.
Kidney stones and acute kidney injuries caused by trauma, illness, or surgery may predispose patients to end-stage renal disease (ESRD), a pair of new cohort studies suggests.

Close follow-up is important, the researchers say. Lifestyle changes and medication can help slow the progression of chronic kidney disease (CKD) and may reduce the incidence of ESRD.

The first study focused on elderly patients aged >67 years. Allan J. Collins, MD, of the U.S. Renal Data System in Minneapolis, led a team that used Medicare claims to create a cohort of 233,803 patients who were hospitalized for any reason in 2000. None had a previous history of kidney injury or ESRD before admission (J Am Soc Nephrol. 2009;20:223-228).

The incidence of kidney injury at baseline was 3.1%, but nearly three quarters of these patients developed CKD within two years. They were also almost seven times more likely to progress to ESRD than patients who had never been injured.

Likelihood of ESRD rose steadily after hospital discharge among patients with a history of injury but no CKD (0.96% within 30 days, 2.69% within 180 days, 4.08% within 365 days, and 6.96% at the end of two years of follow-up). Similar data for patients with no injury were 0.04%, 0.14%, 0.25%, and 0.49%, respectively.

“These findings suggest that CKD may be unrecognized or that injury can initiate CKD, which
can progress to ESRD,” the researchers conclude.

Meanwhile, a general cohort study at the Mayo Clinic in Rochester, Minn., found that people who have had kidney stones are 60% more likely to develop CKD and 40% more likely to progress to ESRD than those who have never formed stones. Patients who have kidney stones plus other CKD risk factors may be at even greater risk for progression, according to investigators.
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