Non-recovery of kidney function after AKI
Research type
Research Study
Full title
Non-recovery of kidney function after AKI: identifying high risk groups and assessment with multiparametric renal MRI
IRAS ID
302569
Contact name
Nicholas Selby
Contact email
Sponsor organisation
The University of Nottingham
Duration of Study in the UK
0 years, 8 months, 30 days
Research summary
Research Summary
One in five patients admitted to hospital suffer a sudden reduction in kidney function, termed acute kidney injury (AKI). Rather than kidney ‘injury’ being caused by physical trauma, the term describes reversible damage caused by conditions such as being dehydrated or having an infection. Having AKI puts patients at an increased risk of long-term health problems, especially chronic kidney disease (CKD). CKD can also lead to other important health problems including a higher risk of heart disease and stroke. If we can reduce the progression of AKI to CKD this will benefit patients.
Currently, there is a gap in the follow-up of patients after AKI due to a lack of evidence about which patients should be followed up and when. Treatments for AKI during the episode and afterwards to prevent CKD are limited. This is mainly due to a lack of understanding about how and when the kidney recovers after AKI. New tools are needed in order to better identify patients at risk of CKD after AKI. This study aims to address these gaps in our knowledge by studying a group of AKI patients in detail.
At the moment the most used way of looking at the kidneys is a basic ultrasound scan. Unfortunately, this provides very limited information, which is often not helpful for the medical team looking after patients with kidney problems. New types of MRI scans have been developed that produce detailed images of the kidneys as well as providing other measures of how well the kidney is working. These new MRI scans are not yet used for patient care, so we want to perform a research study to establish whether MRI scan can improve follow-up of patients with AKI.
Ultimately, the aim of this study is to produce results that will allow better planning of follow-up for patients as well the planning of future research to develop new treatments to reduce the risk of CKD in people recovering from AKI.
The timing of the renal recovery phase after AKI is poorly understood. We do know, however that failure to recover by 90 days is strongly associated with subsequent CKD. The mechanism whereby AKI leads to CKD is arguably one of the most important unanswered questions in nephrology.
The overall aim of this study is to better understand and describe the recovery phase of acute kidney injury (AKI). Over 6 months, I will enrol 50 people with acute AKI in a general hospital setting to this study. All of these patients will undergo detailed assessment about the cause of their AKI and then their progress will be observed until 90 days. 10 people from this main cohort will also undergo a multiparametric renal MRI scan at day 30 and 90.
Ultimately, the aim of this study is to generate results which will provide the basis of further work in this key area. More evidence is needed to allow better planning of follow-up for patients as well as planning future research to develop new treatments. If successful, renal MRI could be integrated into clinical practice, enhancing care and improving identification of patients most at risk of developing CKD after AKI.
Lay Summary of Results
One in five patients admitted to hospital suffer a sudden reduction in kidney function, termed acute kidney injury (AKI). Rather than kidney ‘injury’ being caused by physical trauma, the term describes reversible damage caused by conditions such as being dehydrated or having an infection. Having AKI puts patients at an increased risk of long-term health problems, especially chronic kidney disease (CKD). CKD can also lead to other important health problems including a higher risk of heart disease and stroke. If we can reduce the progression of AKI to CKD this will benefit patients.
Currently, there is a gap in the follow-up of patients after AKI due to a lack of evidence about which patients should be followed up and when. Treatments for AKI during the episode and afterwards to prevent CKD are limited. This is mainly due to a lack of understanding about how and when the kidney recovers after AKI. New tools are needed in order to better identify patients at risk of CKD after AKI. This study aims to address these gaps in our knowledge by studying a group of AKI patients in detail.
In this study we had 122 participants with predominantly severe AKI. Rates of non-recovery of kidney function were high, adding to a large body of evidence that AKI is an important cause for CKD. Whilst there is some dynamic change over time, most changes are observed by day 30, suggesting the key time for renal repair may be the first 30 days. This is important when considering the timing of future interventional strategies, suggesting that interventions need to be implemented prior to 30 days.
In our cohort, AKI duration appeared more important than AKI stage with respect to those who had adverse kidney events. The prospective nature of the study allows for assessment of quality of life measures. Patients with adverse kidney events outcomes have poorer quality of life and significantly more fatigue. This shows that adverse kidney events is also an important outcome from the patient perspective as it associates with lower quality of life.REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
21/EM/0234
Date of REC Opinion
20 Oct 2021
REC opinion
Favourable Opinion