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Does acute kidney disease following primary percutaneous coronary intervention lead to chronic kidney disease development and progression?

The development of acute kidney injury (AKI) during hospitalization has been shown to be associated with shortterm and long-term mortality, new-onset chronic kidney disease (CKD), higher resource utilization, and an increased risk of rehospitalization. Nonrecovery from AKI is emerging as a potential factor influencing these adverse events and is related to the severity, duration, and recurrent episodes of AKI. Underlying comorbidities including diabetes, CKD, proteinuria, and advanced age have been identified as risk factors for AKI nonrecovery [1,2]. Processes of care including fluid balance, dialysis requirement, and follow-up also influence the degree of recovery [3,4]. The ADQI group has recently reported a consensus statement proposing a standardized classification for recovery [5]. Rapid reversal is considered when serum creatinine is back to reference value within 48 h; early recovery within 7 days and late recovery within 7–90 days. Patients with late recovery are classified as AKD and the degree of dysfunction determined as the AKI staging. These kidney function trajectories can occur in patients with de novo AKI or AKI on CKD. However, the heterogeneity of AKI etiology, its recognition and management has been a limiting factor in identifying these events in epidemiologic studies and for individualized patient management. A key issue is the difficulty in distinguishing a new episode of AKI from pre-existing CKD and persistent AKI with incomplete recovery [6–8].