Long term risk of cardiovascular events after acute kidney injury (aki)

Background- AKI leads to elevation in inflammatory cytokines, dysregulation of mineral metabolism, endothelial dysfunction which leads to adverse effects on the cardiovascular system such as structural cardiac damage, cardiac inflammation, cellular apoptosis and necrosis. It can thus predispose a patient to a higher risk of cardiovascular events in the long term. Here we evaluate the association of AKI with a higher risk of cardiovascular outcomes on follow up of 1 year .
Materials And Methods- This retrospective observational study was performed in Department of Medicine at SRMSIMS, Bareilly for duration of 12 months (1st august 2018 to 1st august 2019). A total of 218 patients out of the total patients of AKI who were admitted in the Department of Medicine and Nephrology within the study period were taken and followed up for a year. 72 patients out of 218 had cardiovascular outcomes, were taken in to this study. Patients who had confirmed consent and were fit to the inclusion criteria were recruited for this study.
Results- The present study revealed that the majority of the patients with cardiovascular outcomes were above the age of 50 and had presented in stage 2 and 3 of AKI earlier. Many of these patients had associated co morbidities, were on medications and had various risk factors which could predispose them to the development of cardiovascular related events. It was observed that CHF occurred in 31 out of the 218 patients taken into account; ischemic heart disease occurred in 19 patients, stroke occurred in 8 patients, while 2 of them had progressed to chronic kidney disease. 10 patients had developed atrial fibrillation and 2 of the patients had died.
Conclusion- AKI induces structural cardiac damage, cardiac inflammation and cellular apoptosis and necrosis. Other possible cellular mechanisms of cardiac injury AKI include local inflammation, cellular energy regulation through altered mitochondrial function, fibrosis and immune responses.
In conclusion, an episode of AKI was independently associated with a higher risk of cardiovascular events on follow up.