TUGAS METODOLOGI PENELITIAN

A Prospective Cohort Study of Acute Kidney Injury and Kidney Outcomes,

Cardiovascular Events, and Death

Disusun oleh:

Nama : Hasna Ulya Annafis

NIM : M0621021

Kelas :B

PROGRAM STUDI S-1 FARMASI

FAKULTAS MATEMATIKA DAN ILMU PENGETAHUAN ALAM

UNIVERSITAS SEBELAS MARET

2023
Cara menemukan paper :
1. Menggunakan database Manchester
2. Keyword yang digunakan kidney injury, treatment
3. Memakai “and” yaitu “kidney injury and treatment”
Alasan memilih paper :
1. Karena membahas gagal ginjal serta hubungannya terhadap adanya komplikasi lain
2. Data yang digunakan untuk riset banyak
3. Telah disitasi sebanyak 72 kali dan masih disitasi sampai sekarang (oktober 2023)
Akses Url : https://doi.org/10.1016/j.kint.2020.06.032

I. Introduction
Acute kidney injury can be defined as a sudden decrease in kidney function. The
presence of acute kidney injury is associated with excess risks of death, kidney disease
progression, and cardiovascular events. Moreover, with the Covid-19 pandemic, the
potential for acute kidney injury is becoming increasingly highlighted. The incidence of AKI
is associated with higher incidence rates of chronic kidney disease (CKD), CKD progression,
heart failure events and all-cause death.
Acute kidney injury (AKI) is one of the diseases that causes a high risk of death. The
presence of acute kidney injury (AKI) is associated with cardiovascular complications based
on previous research. The limitation of the research that has been carried out is that it only
examines clinical complications after acute Kidney injury. In addition, hospitalized patients
may have a higher risk of acute kidney injury, not always compared with hospitalized
patients without AKI. With this, there is a need for clinical guidelines according to research,
so this study aims to overcome this problem by prospectively examining the relationship
between AKI and its consequences which include kidney-related consequences, heart failure,
major atherosclerotic cardiovascular events (MACE), and death among matched adults
surviving a hospitalization with or without AKI. This study hypothesizes that AKI has an
independent relationship with a higher risk of other complications.

II. Methodology
Data was collected on 769 adult patients treated in hospitals and 4 clinical centers in
North America and 769 without AKI. A total of 769 participants with AKI aged 18 – 89 years
were recruited from hospitals in medical and surgical wards and ICUs at 4 Kaiser
Permanente health centers (Oakland, Walnut Creek, Hayward, and San Francisco, CA).
Then, in critically ill patients as well as patients hospitalized in the Vanderbilt Medical
Center (Nashville, TN) ICU and medical and surgical wards, adult participants into the
TRIBE-AKI Consortium33 during preoperative evaluation for cardiac surgery at Yale
University (New Haven, CT) and London Health Sciences Center (Ontario, Canada). The
University of Washington enrolled participants from the ICU and medical and surgical wards
at Harborview Medical Center (Seattle, WA).
Criteria used for AKI sufferers during in the hospital were on an increase of ≥50% or
≥0.3 mg/dl in serum creatinine concentration above an outpatient, non-emergency
department baseline value within 7 to 365 days before the index admission. With this, the
 aim is to determine the severity of AKI. Matching is carried out first with a weighted and
integrated priority score (0-100) with 30 points (cardiovascular disease), 25 points (diabetes
mellitus), 20 points (epidemology of chronic kidney disease), 15 points (age category) and
10 points (care ICU during hospitalization). Participants had a baseline outpatient, non–
emergency department serum creatinine value within 365 days before enrollment. Major
exclusion criteria included inability to provide consent; hepatorenal syndrome; acute
glomerulonephritis; metastatic or actively treated malignancy; multiple myeloma,
significant urinary tract obstruction; severe heart failure; death, receiving chronic dialysis,
kidney, or other transplant before the 3-month postdischarge baseline visit; pregnant or
breastfeeding.

III. Result
A. Baseline characteristic
Based on research that has been conducted, 1,603 adult participants hospitalized
with or without acute kidney injury were eligible for enrollment (769 adults with AKI
and 769 adults without AKI). Based on the research, it was found that 3 participants did
not experience acute kidney injury, and 62 participants did not experience acute kidney
injury. Results 1: 1 matched inpatient adults with and without acute kidney injury were
1538. In this study there were 612 participants (39.8%) who already had chronic kidney
disease, 306 participants suffered from acute kidney injury and 306 participants did not
suffer from acute kidney disease. injury. There were 926 participants who did not have
previous chronic kidney disease. The mean follow-up period was 4.5 ±1.8 years overall,
with a mean follow-up period of 4.3 ±1.8 years in participants with AKI and 4.4 ±1.8
years in participants who classified as non-AKI. During follow-up, 82 participants with
AKI and 82 non-AKI participants withdrew from the study.
B. Kidney outcomes
Based on data was obtained, KD incidence was 4.1 per 100 person-years in
participants with AKI compared with 1.8 per 100 person-years in matched adults who
were non-AKI. In participants with preexisting CKD, the rate of those experiencing
CKD progression was 2.1 per 100 person-years in participants with AKI compared with
0.7 per 100 person-years in matched participants who were non-AKI. In multivariable
analysis among matched participants without preexisting CKD, AKI was associated
with a 3.4-fold higher adjusted rate of incident CKD. Further adjustment for additional
demographic characteristics, sepsis during the index admission and smoking, diabetes
status, and body mass index at the baseline visit strengthened the association. AKI was
associated with a 2.3-fold higher adjusted rate of CKD progression in matched
participants, and the association with CKD progression increased after adjustment for
additional potential confounders.
C. Heart failure events
The incidence of hospitalization for heart failure was higher in those with versus
in those without AKI (3.0 vs. 1.1 per 100 person-years, respectively. The pattern was
similar in those with preexisting CKD, with a higher incidence in those with versus in
those without AKI (5.9 vs. 3.9 per 100 person-years). The relative strength of
association was weaker in those with versus in those without preexisting CKD, but the
patterns with multivariable adjustment were similar. In multivariable analysis among
matched participants, AKI was associated with a nearly 2-fold higher adjusted rate of
 heart failure events that was attenuated after additional adjustment for potential
confounders. The relative strength of association was weaker in those with versus in
those without preexisting CKD, but the patterns with multivariable adjustment were
similar.
D. Major atherosclerotic cardiovascular events
In those without underlying CKD, the incidence of MACE was 1.5 per 100
person-years in participants with AKI compared with 1.6 per 100 person-years in
matched participants classified as non-AKI. There was also no significant difference in
MACE incidence between those with CKD with AKI and those without AKI (3.6 vs.
3.1 per 100 person-years). Results were unchanged in multivariable analyses. There was
also no significant association between AKI severity and MACE. Results were similar
to the main analysis in a sensitivity analysis among the subset of participants—AKI and
non-AKI—that were exactly matched on all matching criteria.
E. Mortality
There was a significant trend of more severe AKI with excess mortality that was
attenuated and no longer significant after adjustment for 3-month postdischarge kidney
function and proteinuria, while longer AKI duration was independently associated with
higher mortality (Supplementary Appendices S2 and S3). In sensitivity analyses in the
subset of participants—AKI and non-AKI—that were exactly matched on all matching
criteria, results were similar to the main analyses, except that AKI was independently
associated with a nearly 2-fold higher rate of death in those with preexisting CKD even
after additional adjustment for 3-month postdischarge kidney function and proteinuria.

IV. Conclusion
AKI independently associated with higher rates of incident and progressive CKD, as
well as subsequent heart failure events and death among survivors of a recent hospitalization.
However, after additionally accounting for degree of renal recovery and proteinuria status 3
months after discharge, the associations of AKI with heart failure and death were not
significant. More severe and longer AKI duration may also be associated with worse clinical
outcomes. Our study provides new data to support system atically evaluating level of kidney
function recovery and proteinuria 3 months after an episode of AKI to provide relevant
prognostic information that may help guide clinical decision making. Furthermore, definitive
randomized trial evidence is needed to determine whether strategies to prevent AKI or
interventions early in the course of AKI can reduce the risks of future adverse renal and
cardiovascular outcomes.