Blog entry by Arif Khwaja

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by Arif Khwaja - Friday, 8 June 2012, 8:26 AM
Anyone in the world

There is a nice debate in this months JASN between Rifkin and Hsu about whether AKI leads to CKD. This is timely as the recent KDIGO guidelines have suggested that AKI be considered a risk factor for CKD - the logical implication of this being that all patients with AKI (including those who have completely 'recovered') be monitored for life for CKD. Rifkin and colleagues pint out that whilst its certainly biologically plausible for AKI to lead to CKD, there may be common risk factors of kidney injury that independently predispose to both AKI or CKD and furthermore its entirely plausible that CKD itself may predispose to AKI. In many ways I find the argument a bit sterile... have we not known for many years that if the AKI 'hit' is severe enough then people may be left with residual CKD whilst those wilth mild AKI appear to recover fully. As Rifkin and colleagues point out more than 500,000 AKI events occur in in the USA every year and the the vast majority recover without any significant longterm complication. The idea that all these patients need lifelong monitoring in case they get CKD is neither economically viable nor based on sound clinical judgement. An obviously pragmatic approach would be to monitor those who had severe or dialysis dependent AKI for a few years to see if CKD develops. In contrast its hard to believe that those whos have mild AKI that resolves quickly (with no comorbidity) will benefit from lifelong screening for CKD. Clearly longterm observational studies if AKI may help resolve this debate but in the meantime I suspect most nephrologist will be able to get buy just using clinical common sense....  

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