Recovery for AKI is variable and depends on cause of injury and the severity and duration of AKI.[150]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67.
https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com
[151]Mehta S, Chauhan K, Patel A, et al. The prognostic importance of duration of AKI: a systematic review and meta-analysis. BMC Nephrol. 2018 Apr 19;19(1):91.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907696
http://www.ncbi.nlm.nih.gov/pubmed/29673338?tool=bestpractice.com
There is an independent association of AKI with a higher risk of death.[9]Wang HE, Muntner P, Chertow GM, et al. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol. 2012;35(4):349-55.
https://www.karger.com/Article/FullText/337487
http://www.ncbi.nlm.nih.gov/pubmed/22473149?tool=bestpractice.com
[150]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67.
https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com
[152]Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: systematic review and meta-analysis. Am J Kidney Dis. 2009 Jun;53(6):961-73.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726041
http://www.ncbi.nlm.nih.gov/pubmed/19346042?tool=bestpractice.com
In-hospital mortality rates associated with AKI vary from 6% to 80%, and there is increased long-term mortality in those with AKI surviving hospitalization.[152]Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: systematic review and meta-analysis. Am J Kidney Dis. 2009 Jun;53(6):961-73.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726041
http://www.ncbi.nlm.nih.gov/pubmed/19346042?tool=bestpractice.com
Up to 6% of patients admitted to the intensive care unit have AKI requiring renal replacement therapy.[16]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
[150]Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-67.
https://www.kidney-international.org/article/S0085-2538(15)55991-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23636171?tool=bestpractice.com
[153]Tao Li PK, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Int J Organ Transplant Med. 2013;4(1):1-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089304
http://www.ncbi.nlm.nih.gov/pubmed/25013646?tool=bestpractice.com
In hospital, when AKI requires dialysis, mortality exceeds 50%; those with multiorgan failure are at greatest risk.[13]Mehta R, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21.
http://www.ncbi.nlm.nih.gov/pubmed/15458458?tool=bestpractice.com
[16]Liangos O, Wald R, O'Bell JW, et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006 Jan;1(1):43-51.
https://cjasn.asnjournals.org/content/1/1/43.long
http://www.ncbi.nlm.nih.gov/pubmed/17699189?tool=bestpractice.com
[153]Tao Li PK, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Int J Organ Transplant Med. 2013;4(1):1-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089304
http://www.ncbi.nlm.nih.gov/pubmed/25013646?tool=bestpractice.com
Mortality rates are high due to death from underlying disease and complications, not just the AKI.
Five-year survival rates in patients with AKI requiring renal replacement therapy range from 15% to 35% (less than 10% of those patients are dialysis-dependent).[154]Rimes-Stigare C, Awad A, Mårtensson J, et al. Long-term outcome after acute renal replacement therapy: a narrative review. Acta Anaesthesiol Scand. 2012 Feb;56(2):138-46.
http://www.ncbi.nlm.nih.gov/pubmed/22092145?tool=bestpractice.com
AKI is irreversible in approximately 5% to 7% of adults and as many as 16% of older adult patients.[155]Bhandari S, Turney JH. Survivors of acute renal failure who do not recover renal function. QJM. 1996 Jun;89(6):415-21.
http://www.ncbi.nlm.nih.gov/pubmed/8758044?tool=bestpractice.com
There is controversy as to whether prior AKI is a major risk factor leading to future chronic kidney disease, but evidence increasingly favors a strong association.[156]Rifkin DE, Coca SG, Kalantar-Zadeh K. Does AKI Truly Lead to CKD? J Am Soc Nephrol. 2012 Jun;23(6):979-84.
http://www.ncbi.nlm.nih.gov/pubmed/22460531?tool=bestpractice.com
[157]Leung KC, Tonelli M, James MT. Chronic kidney disease following acute kidney injury: risk and outcomes. Nat Rev Nephrol. 2013 Feb;9(2):77-85.
http://www.ncbi.nlm.nih.gov/pubmed/23247572?tool=bestpractice.com
[158]Bucaloiu ID, Kirchner HL, Norfolk ER, et al. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012 Mar;81(5):477-85.
http://www.ncbi.nlm.nih.gov/pubmed/22157656?tool=bestpractice.com
[159]See EJ, Jayasinghe K, Glassford N, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019 Jan;95(1):160-72.
https://www.kidney-international.org/article/S0085-2538(18)30643-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/30473140?tool=bestpractice.com