Jessica B. Kendrick, MD, on Whether Acute Kidney Injury Could Impact the Brain
New research presented at the American Society of Nephrology’s Kidney Week 2018 suggests that patients who recover from an acute kidney injury (AKI) likely still face cerebrovascular consequences.
According to a retrospective propensity-matched analysis of 2082 patients from an integrated health care delivery system in Utah, AKI with complete kidney recovery is likely associated with a heightened risk of developing subsequent dementia.
Consultant360 spoke with the study’s lead author, Jessica B Kendrick, MD, associate professor at the University of Colorado Denver, about the concerning findings and the vital need for more data in this area.
Consultant360: How did your study come about? What prompted you to assess dementia risk in patients with AKI?
Jessica Kendrick: I primarily study cardiovascular and cerebrovascular risks in patients with chronic kidney disease. I became interested in the long-term complications of AKI and had found that no studies had really investigated the potential long-term cerebrovascular and neurologic complications in patients with AKI.
C360: Your study found that patients with AKI, even with complete recovery of kidney function, likely have a significantly increased risk of hospitalized dementia following AKI. Why do you think this was the case?
JK: The answer to this question is not yet clear. Right now, we know that AKI is associated with an increased risk of progression to end-stage renal disease and cardiovascular events. My hypothesis is that patients who have AKI also experience vascular dysfunction as a result, and even if their kidney function fully recovers, their vascular function may not. I think that this is an area we need to research now.
Going forward, we need to determine why patients with AKI have this increased risk of dementia. We can perform different hemodynamic tests to see whether the cerebral blood vessels are being permanently damaged with AKI.
C360: Did your study identify whether or not dementia risk could be even worse in AKI patients without complete kidney recovery?
JK: That is an area that will require further research. In this study, we only assessed patients that had complete kidney function recovery. Now, we are going to go back and look at the patients who did not meet our definition of complete recovery and determine whether or not they have an even higher risk of dementia compared with patients who completely recovered.
C360: Is there anything that can be done to mitigate the risks for dementia in AKI patients, or might these risks be unavoidable?
JK: That is a great question. I do not think the answer is yet clear. I think we had always assumed that, in patients with AKI who experience complete recovery, there were not really any long-term consequences. Now, more and more data show that there are.
Currently, there is a desperate need for data so that we can better understand what can be done for these patients once they have recovered in order to prevent these long-term consequences.
C360: What are the clinical takeaways of your study? How can clinicians apply these findings in practice?
JK: Clinicians should know that AKI is obviously associated with very poor long-term outcomes, and as clinicians, we really need to figure out how to prevent the long-term consequences of AKI. We may need to be more diligent in our follow-up of these patients. For example, patients with AKI do not usually see a nephrologist if they experience complete recovery after they leave the hospital. Perhaps they need to be followed by a nephrologist.
C360: Did your study imply any other areas for further research?
JK: I think the biggest research needs right now are figuring out how to reduce the long-term consequences of AKI and understanding the mechanism between AKI and dementia. Once we do that, we can actually identify interventions that could hopefully improve outcomes in these patients.
—Christina Vogt
Reference:
Kendrick JB, Holmen JR, Srinivas T, You Z, Chonchol M, Jovanovich AJ. AKI is associated with an increased risk of dementia. Paper presented at: American Society of Nephrology Kidney Week 2018; October 23-28, 2018; San Diego, CA.