CKD Progression after Acute Kidney Injury
Bibliographic record
Abstract
Key Points Development or progression of CKD occurred in almost 40% of patients after an episode of severe AKI. Receipt of KRT, regardless of allocation to an accelerated or standard initiation strategy, was associated with development or progression of CKD. This study helps identify a subset of patients at risk of CKD after severe AKI who would benefit from dedicated kidney follow-up after discharge. Background CKD is a common complication after AKI. We aimed to evaluate whether a KRT initiation strategy had an effect on CKD progression. Secondarily, we aimed to identify factors that influenced the development or progression of CKD after severe AKI. Methods This secondary analysis of the Standard versus Accelerated Initiation of Renal Replacement Therapy in AKI trial included patients with outpatient serum creatinine values available in the year before hospitalization and who were alive at 90 days after randomization. Our main analysis focused on patients who had definitive assessment of kidney function at 90 days after randomization. Predictor markers included patient demographics, comorbidities, markers of acute illness, laboratory values, receipt of KRT, and KRT treatment strategy (accelerated versus standard). The primary outcome was CKD progression, a composite of de novo CKD, defined as new eGFR <60 ml/min per 1.73 m 2 if baseline eGFR was ≥60 ml/min; a decline in eGFR ≥25% if baseline eGFR was <60 ml/min; or KRT dependence at day 90. The association of KRT treatment strategy with CKD progression was assessed in an unadjusted mixed-effect logistic regression model. Results Of the 401 surviving patients with a baseline serum creatinine, 39% experienced CKD progression. KRT initiation strategy had no effect on CKD progression (accelerated arm [41%], versus the standard arm [38%], odds ratio, 1.13 [95% confidence interval, 0.75 to 1.72]). Receipt of KRT and aortic surgery were the most potent risks of CKD progression. Conclusions These findings suggest that CKD progression is common after severe AKI. Risk factors of CKD progression included receipt of KRT and aortic surgery, suggesting that these patients should be prioritized for dedicated kidney follow-up after hospital discharge. Clinical Trial registry name and registration number: NCT01557361.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.015 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".