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Research by the authors is supported by the Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001) and FEDER funds. The Open Access is financially supported by BI. BI had no role in the design, analysis or interpretation of the results in this study. BI was given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations.

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Ortiz, AAuthor

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September 12, 2022
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Infectious consequences of the AKI-to-CKD transition

Publicated to:Clinical Kidney Journal. 15 (12): 2237-2244 - 2022-12-01 15(12), DOI: 10.1093/ckj/sfac178

Authors: Sanchez Horrillo, Ana; Salanova Villanueva, Laura; Cabrera Cardenas, Alicia; Munoz Ramos, Patricia; Ortiz, Alberto; Quiroga, Borja;

Affiliations

Fdn Renal Inigo Alvarez Toledo IRSIN, Inst Invest Carlos III, Madrid, Spain - Author
Hosp Univ La Princesa, Inst Invest Sanitaria La Princesa, Nephrol Dept, Madrid, Spain - Author
Univ Autonoma Madrid, Inst Invest Sanitaria Fdn Jimenez Diaz, Sch Med, Madrid, Spain - Author

Abstract

Background Acute kidney injury (AKI) is associated with short- and long-term complications but the consequences of the AKI-to-CKD transition are still poorly understood. We aimed to evaluate the association between the AKI-to-CKD transition and the long-term risk of infection. Methods This retrospective study included patients admitted in a tertiary hospital with community-acquired AKI in 2013 and 2014 who had their estimated glomerular filtration rate (eGFR) assessed at 3 months (+/- 2 weeks) after serum creatinine peaked in the AKI episode. Key exclusion criteria were baseline CKD or confounding factors (active neoplasia, primary immunodeficiency, human immunodeficiency virus, immunosuppressive drugs). The association between the AKI-to-CKD transition (defined as an eGFR <60 ml/min/1.73 m(2) at 3 months) and long-term infections (defined using clinical features, blood/urine analysis, cultures and imaging) was assessed during a follow-up of 9 months (range 2-56). Results Among the 1731 patients admitted with AKI, 367 (21%) were included in the present analysis (64% male, 71 +/- 15 years). Three months after AKI, 159 (43%) developed AKI-to-CKD transition. Baseline and post-AKI eGFR were independent predictors of AKI-to-CKD transition [hazard ratio (HR) 0.97, P = .044 and HR 0.96, P < .001, respectively]. During follow-up, 153 (42%) patients developed an infection. Factors associated with infection were older age, cognitive impairment, lower post-AKI eGFR, eGFR loss from baseline to 3 months and AKI-to-CKD transition. Adjusted Cox regression showed that baseline eGFR, 3-month eGFR, eGFR loss and AKI-to-CKD transition were independent predictors of the long-term risk of infection. Conclusions The AKI-to-CKD transition independently predicts the long-term risk of infection following an episode of AKI.

Keywords

Acute kidney injuryChronic kidney diseaseGfrInfectionsMortalityOutcomesPersistent kidney damageRenal-diseaseRisk

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Clinical Kidney Journal due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 17/88, thus managing to position itself as a Q1 (Primer Cuartil), in the category Urology & Nephrology.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 3.48, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-03, the following number of citations:

  • WoS: 1
  • Scopus: 3
  • Europe PMC: 1

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-08-03:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 8.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 11 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 17.85.
  • The number of mentions on the social network X (formerly Twitter): 10 (Altmetric).
  • The number of mentions in news outlets: 2 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
  • Assignment of a Handle/URN as an identifier within the deposit in the Institutional Repository: https://repositorio.uam.es/handle/10486/714613