Date Published: February 10, 2017
Publisher: Public Library of Science
Author(s): Yuanyuan Xie, Qin Wang, Chunlin Wang, Xiajing Che, Xinghua Shao, Yao Xu, Zhaohui Ni, Shan Mou, Cordula M. Stover.
The factors influencing the prognosis of acute kidney injury (AKI) were analyzed in a group of elderly AKI patients to determine the markers of early prognosis.
A total of 258 patients were screened, and 201 patients were enrolled in the study. Eventually, 184 AKI patients were included in the study, including 79 elderly AKI patients (≥60 years old). During one year of follow-up, renal function changes were observed, and the risk factors that influenced the prognosis of AKI were analyzed.
When AKI occurred, the urine kidney injury molecule-1 (uKIM-1) level was significantly higher in the progressive deterioration of renal function group than in the renal function stable group. The ROC curve analysis revealed that the area under the curve for poor progressive deterioration of renal function as predicted by the uKIM-1 level was 0.681. At a cutoff point of 2.46 ng/mg, the sensitivity was 71.9% and the specificity was 70.0%. In elderly AKI patients, uKIM-1 levels exceeding 2.46 ng/mg were positively associated with poor kidney prognosis.
Elderly AKI patients are at risk of developing progressive deterioration of renal function. In elderly AKI patients, the high uKIM-1 level may predict the prognosis of kidney function and may be used as an early screening indicator of poor kidney prognosis.
Among inpatients, acute kidney injury (AKI) is a common complication, with a high incidence and poor prognosis. AKI consumes a large amount of societal medical resources . Provide specific therapies for the cause of AKI. Apply renal replacement therapy if necessary. In recent years, more studies have concentrated on the relationship between AKI and chronic kidney disease (CKD). Compared with young patients, elderly AKI patients can easily progress to CKD or end-stage renal disease (ESRD) [2–4]. Urinary kidney injury molecule-1 (uKIM-1) is a marker of epithelial injury of renal tubules, and it is elevated in the early stages of AKI . Different uKIM-1 levels are associated with various degrees of renal injuries. For this study, the factors influencing kidney prognosis were analyzed in a group of elderly AKI patients to determine the markers of early prognosis.
AKI is a common clinical syndrome that primarily presents with a rapid decrease in renal function and an accumulation of metabolic waste. For many years, AKI was considered to be a self-limiting disease. However, in recent years, the incidence of CKD has gradually increased in conjunction with an increased incidence of AKI. More studies have reported that some AKI patients do not completely recover and gradually progress to CKD and ESRD, with some patients even requiring permanent kidney replacement therapy [10, 11]. Research data indicated that CKD progression may be influenced by AKI [12, 13]. A total of 184 AKI inpatients were enrolled into the current study, and after one year of regular follow-up, progressive deterioration of renal function was observed in 40% patients. The results demonstrated that AKI may lead to CKD, which is consistent with the results of previous studies . It is still unknown why AKI increases the risks of CKD and ESRD. Animal experiments have demonstrated  that AKI can lead to kidney fibrosis while concurrently damaging the lungs, heart, and liver. Although AKI is generally reversible, in the event of serum creatinine concentration recovery there may be subclinical damage to the kidney and extra-renal organs. This damage will continue, perhaps leading to CKD and even ESRD.
Elderly AKI patients are at risk of progressive deterioration of renal function. uKIM-1 is a good biomarker of AKI in elderly patients, and uKIM-1 levels can effectively distinguish between transient AKI and non transient AKI. In addition, uKIM-1 levels accurately predict the kidney prognosis in elderly AKI patients and may be used as an early screening indicator of poor kidney prognosis. The results of this study can help to develop new treatment strategies to assist clinical physicians in providing earlier interventions to mitigate renal progression after AKI. The renal functions of elderly patients with a history of AKI should be closely monitored.