CINXE.COM

<!DOCTYPE html> <html id="doc" lang="en" class="page-article"> <head id="Head1">  <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <script> var SCM = SCM || {}; if (SCM.AMA && SCM.AMA.DataLayerAsync) { SCM.AMA.DataLayerAsync.push("arrSisAffinity", "", "array"); SCM.AMA.DataLayerAsync.push("SubStatus", "no", "string"); } var googletag = window.googletag || {}; googletag.cmd = googletag.cmd || []; if (typeof Storage !== "undefined") { var targetingParamStr = localStorage.getItem("bcDFPTargetingParams"); if (targetingParamStr) { var targetingParameters = JSON.parse(targetingParamStr); // set page-level targeting parameters jQuery.each(targetingParameters, function (index, param) { googletag.cmd.push(function () { window.googletag.pubads().setTargeting(param.key, param.value); }); }); } } if (!googletag.pubads) { (function () { var gads = document.createElement('script'); var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 'https:' : 'http:') + '//securepubads.g.doubleclick.net/tag/js/gpt.js'; gads.setAttribute("async", ""); gads.setAttribute("defer", ""); var node = document.getElementsByTagName('script')[0]; node.parentNode.insertBefore(gads, node); })(); var App = App || {}; App.Ads = App.Ads || {}; App.Ads.adPath = App.Ads.adPath || '/6479/' + 'ama.jama'; App.Ads.Mappings = App.Ads.Mappings || {}; App.Ads.slots = App.Ads.slots || []; App.Ads.fromGoogle = !('yes' === 'yes'); App.isCollection = App.isCollection || !!document.getElementsByClassName('pg_collection').length; googletag.cmd.push(function () { googletag.pubads() .setTargeting('environment', ['newjama']) .setTargeting('site', ['ama.jama']) .setTargeting('sect', ['scholarly']) .setTargeting('sub', ['no']) .setTargeting('device', ['Mozilla%2F4.0%20%28compatible%3B%20MSIE%207.0%3B%20Windows%20NT%206.0%3B%20SLCC1%3B%20.NET%20CLR%202.0.50727%3B%20.NET%20CLR%203.0.04506%3B%20.NET%20CLR%203.5.21022%3B%20.NET%20CLR%201.0.3705%3B%20.NET%20CLR%201.1.4322%29']) .setTargeting('usaphys', ['no']) .setTargeting('memberstat', ['no']) .setTargeting('pracset', ['']) .setTargeting('specialty', ['other']) .setTargeting('occupation', ['']) .setTargeting('useraffinity', ['']) .setTargeting('direct', ['yes']) .setTargeting('bot', ['']) .setTargeting('datacenter', ['no']) .setTargeting('selfMPA', ['']) .setTargeting('selfSpecialty', ['']); if (App.isCollection) { googletag.pubads().setTargeting('collection', ['']); } var testParam = getQueryVariable('test'); if (testParam) { googletag.pubads().setTargeting('test', [testParam]); } function getQueryVariable(variable) { var query = window.location.search.substring(1); var vars = query.split('&'); for (var i = 0; i < vars.length; i++) { var pair = vars[i].split('='); if (decodeURIComponent(pair[0]) == variable) { return decodeURIComponent(pair[1]); } } } googletag.pubads().disableInitialLoad(); googletag.enableServices(); }); } </script> <meta name="viewport" content="width=device-width, initial-scale=1" /><meta name="format-detection" content="telephone=no" /><link rel="shortcut icon" href="//cdn.jamanetwork.com/UI/app/img/favicons/jama/favicon.ico"> <link rel="icon" type="image/png" href="//cdn.jamanetwork.com/UI/app/img/favicons/jama/favicon-192x192.png" sizes="192x192"> <link rel="apple-touch-icon" sizes="180x180" href="//cdn.jamanetwork.com/UI/app/img/favicons/jama/apple-touch-icon-180x180.png"> <meta http-equiv="X-UA-Compatible" content="IE=Edge" /> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/dist/app.min.css?v=638677764476993385"> <link href="//cdn.jsdelivr.net/chartist.js/latest/chartist.min.css" type="text/css" rel="stylesheet" /> <meta property="og:title" content="Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis" /> <meta property="og:type" content="Article" /> <meta property="og:url" content="https://jamanetwork.com/journals/jama/fullarticle/184587" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f1.png?Expires=2147483647&Signature=MtinyShFaeZgr4qTrvQA37z2b-sg11Uf7cGkxYpOFdatiZamw0ycsGeR25eO0hJ6RvaiiHepTX9SvKjVsTGf5rTSY2hrZyWoXh5fO0HqE8FIeYLYbzW2Jt4IdanO8vUa8BcOVZzThKJFPEabLUgVTpNXQiDs9qKrZd2QMLQf3Ols9nO8yKByj2bxjQ8iOAL2GkledMmXGBFLO7Q4tdyDLNrfEYIUNoWOAjMOp8M1YumnzTUnOydK4XQ2v5zTSu7tvk96ZZ2ig55InSyVr0rNXPGNE6MsBWG348hXvCtEzh9VEUnxa4BilkLsvb76azFKfkCn92dSJUXm7Kv9XImrTg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t1.png?Expires=2147483647&Signature=YBHOhBiHCE73dM8o8jMewI2~4Ds8QqIvkayN0ipFdbxXi0zREuKhHw13vaHPwu5N1zBtbj6GQXsYKDylIuzICNkEEz75JwC~KpCrzmby9PJvLScLZgurN7~PB1SMcgSJNL-t2PQyaMl6jgsbd3QI4zx1Ti0J47N6N6b40FrT6gKgwxndZ4CwfysvFOs25~3fexRHkb8xuxGHyuJ4Yyhc6Ij6eVwPIvxoNucMFcDHidtaRlKwfn5tGMUhLesV6t7YlJtVvUKjcf6siTegcR20i0vzdJ5FSwmmRNEbQr5gx2tj2FlUr1GAjsZCYn05TFQElTjbgQahUSgArUuvMPpISQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t2.png?Expires=2147483647&Signature=eULf2j9oY71w-4EZVd9htGcATFrc5o~JhoY2Kl1G5W2y4FQZh~rQuknBAh0QNrbhbuViqjU9XvpztD570ZGPrwNRT2C5f7IdyUmsu1cYdKhyfAigBuS4Vz3YTFphRU2MEDRwkfgRVbm4eaCoC2VbXqJLSSml67Smb-C2QhBKL5GrsR1TSVLYZf5kYpYyxv~fu61BATaEAlWb3S11Ng0rrTVGa5J7BFdyYowhh6wQtFo~ikEZEVLl2LocEZiH06DcCN7ulU5vfPC1n~O04o~rvxUN84Qr2P4U2y90rfOWw89WcYvsdZs~zL9GnAXS6pUrnEiF~STi2aIVU9DgfkHD3Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f2.png?Expires=2147483647&Signature=v~lXPjsL8HyJmrWhzTk9FJH6hKDwIvlIDQCJOw1P3zOPYuM8d0TihseWRjtLZkDck-AlgU2V3xoKRsj7hBrY2RB88yICFXabxUfDEudNRiRyao28GJUhZfF1~819JeWFPNuwAl06NWsqBh3zb33nifmt7gJCBXuLCyVAxnwIMgSLejEdBK2KpBPuzoK9iWbe1PWm4yYqeDCfy0foUY8wk9xuhG2m6Iu1QoTl7fUKXkRVKhqGQWLszfxdYBRVBxca-2S3Q92LCx16krS-JpSqq9CWrinPq1BbCpXhWmjuLzI5dMBPabFUaJVJksnaRMUSnDjJ-pnNjzrKa5cXWUVWPQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f3.png?Expires=2147483647&Signature=J-J9iK-6CD5OnoyAyMGjRfdNAKn7rb3ZO1Enl9I97Nu3Led1TQRMzw2whZCsLCTu7ynSDG2So7XHGTP-wnLIq2bhVJ-Ip-nJIiDxneTQ1AhIk3akBYwNyHyiuLhKpicDpf8Oy19sIrmKspQ1tuOn4MjdvaHJ5QlDAY~wS--vBoTG3GAHdINP9~7bb44HK4NaUH8KE2FoTyJvPbB-hl6uSp3k0Bcpwn8lhEDN2kpe8geQabvo6T3bfrDUnJ6nUF4YySuhKALU1DrHD~-sbrorMdgtNApULzGjBSJ7~btSvS4HwMuBJaGRONH3AcZeLcqrxprSnUa3kK2cWiPtx6Rdng__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <meta property="og:description" content="Context Severe acute kidney injury among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who survive to hospital discharge.Objective To assess the risk of chronic dialysis and all-cause mortality in individuals who..." /> <meta property="fb:pages" content="87087958340" /> <meta property="fb:pages" content="122228711814384" /> <meta property="fb:pages" content="1648414928738217" /> <meta property="fb:pages" content="117506346528" /> <meta property="fb:pages" content="97538728726" /> <meta property="fb:pages" content="114116793520" /> <meta property="fb:pages" content="100679858757" /> <meta property="fb:pages" content="759822190741773" /> <meta property="fb:pages" content="100265333750" /> <meta property="fb:pages" content="234770525256" /> <meta property="fb:pages" content="98784919862" /> <meta property="fb:pages" content="120829458202" /> <meta property="fb:pages" content="124842870398" /> <meta property="fb:pages" content="110245330325636" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:site" content="@JAMA_current" /> <meta name="twitter:image" content="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f1.png?Expires=2147483647&Signature=MtinyShFaeZgr4qTrvQA37z2b-sg11Uf7cGkxYpOFdatiZamw0ycsGeR25eO0hJ6RvaiiHepTX9SvKjVsTGf5rTSY2hrZyWoXh5fO0HqE8FIeYLYbzW2Jt4IdanO8vUa8BcOVZzThKJFPEabLUgVTpNXQiDs9qKrZd2QMLQf3Ols9nO8yKByj2bxjQ8iOAL2GkledMmXGBFLO7Q4tdyDLNrfEYIUNoWOAjMOp8M1YumnzTUnOydK4XQ2v5zTSu7tvk96ZZ2ig55InSyVr0rNXPGNE6MsBWG348hXvCtEzh9VEUnxa4BilkLsvb76azFKfkCn92dSJUXm7Kv9XImrTg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" /> <script type="application/ld+json"> { "@context": "https://schema.org/", "@type": "Article", "headline": "Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis", "author": "Ron Wald, MDCM, MPH, FRCPC", "url": "https://jamanetwork.com/journals/jama/fullarticle/184587", "datePublished": "2009-09-16", "description": "Context Severe acute kidney injury among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who survive to hospital discharge. Objective To assess the risk of chronic dialysis and all-cause mortality in individuals who experience an episode of acute kidney injury requiring dialysis. Design, Setting, and Participants We conducted a population-based cohort study of all adult patients in Ontario, Canada, with acute kidney injury who required in-hospital dialysis and survived free of dialysis for at least 30 days after discharge between July 1, 1996, and December 31, 2006. These individuals were matched with patients without acute kidney injury or dialysis during their index hospitalization. Matching was by age plus or minus 5 years, sex, history of chronic kidney disease, receipt of mechanical ventilation during the index hospitalization, and a propensity score for developing acute kidney injury requiring dialysis. Patients were followed up until March 31, 2007. Main Outcome Measures The primary end point was the need for chronic dialysis and the secondary outcome was all-cause mortality. Results We identified 3769 adults with acute kidney injury requiring in-hospital dialysis and 13 598 matched controls. The mean age was 62 years and median follow-up was 3 years. The incidence rate of chronic dialysis was 2.63 per 100 person-years among individuals with acute kidney injury requiring dialysis, and 0.91 per 100 person-years among control participants (adjusted hazard ratio, 3.23; 95% confidence interval, 2.70-3.86). All-cause mortality rates were 10.10 and 10.85 per 100 person-years, respectively (adjusted hazard ratio, 0.95; 95% confidence interval, 0.89-1.02). Conclusions Acute kidney injury necessitating in-hospital dialysis was associated with an increased risk of chronic dialysis but not all-cause mortality.", "publisher": { "@type": "Organization", "name": "JAMA Network", "logo": { "@type": "ImageObject", "url": "//cdn.jamanetwork.com/UI/app/img/favicons/jama/favicon.ico" } }, "image": [ "https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f1.png?Expires=2147483647&Signature=MtinyShFaeZgr4qTrvQA37z2b-sg11Uf7cGkxYpOFdatiZamw0ycsGeR25eO0hJ6RvaiiHepTX9SvKjVsTGf5rTSY2hrZyWoXh5fO0HqE8FIeYLYbzW2Jt4IdanO8vUa8BcOVZzThKJFPEabLUgVTpNXQiDs9qKrZd2QMLQf3Ols9nO8yKByj2bxjQ8iOAL2GkledMmXGBFLO7Q4tdyDLNrfEYIUNoWOAjMOp8M1YumnzTUnOydK4XQ2v5zTSu7tvk96ZZ2ig55InSyVr0rNXPGNE6MsBWG348hXvCtEzh9VEUnxa4BilkLsvb76azFKfkCn92dSJUXm7Kv9XImrTg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t1.png?Expires=2147483647&Signature=YBHOhBiHCE73dM8o8jMewI2~4Ds8QqIvkayN0ipFdbxXi0zREuKhHw13vaHPwu5N1zBtbj6GQXsYKDylIuzICNkEEz75JwC~KpCrzmby9PJvLScLZgurN7~PB1SMcgSJNL-t2PQyaMl6jgsbd3QI4zx1Ti0J47N6N6b40FrT6gKgwxndZ4CwfysvFOs25~3fexRHkb8xuxGHyuJ4Yyhc6Ij6eVwPIvxoNucMFcDHidtaRlKwfn5tGMUhLesV6t7YlJtVvUKjcf6siTegcR20i0vzdJ5FSwmmRNEbQr5gx2tj2FlUr1GAjsZCYn05TFQElTjbgQahUSgArUuvMPpISQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t2.png?Expires=2147483647&Signature=eULf2j9oY71w-4EZVd9htGcATFrc5o~JhoY2Kl1G5W2y4FQZh~rQuknBAh0QNrbhbuViqjU9XvpztD570ZGPrwNRT2C5f7IdyUmsu1cYdKhyfAigBuS4Vz3YTFphRU2MEDRwkfgRVbm4eaCoC2VbXqJLSSml67Smb-C2QhBKL5GrsR1TSVLYZf5kYpYyxv~fu61BATaEAlWb3S11Ng0rrTVGa5J7BFdyYowhh6wQtFo~ikEZEVLl2LocEZiH06DcCN7ulU5vfPC1n~O04o~rvxUN84Qr2P4U2y90rfOWw89WcYvsdZs~zL9GnAXS6pUrnEiF~STi2aIVU9DgfkHD3Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f2.png?Expires=2147483647&Signature=v~lXPjsL8HyJmrWhzTk9FJH6hKDwIvlIDQCJOw1P3zOPYuM8d0TihseWRjtLZkDck-AlgU2V3xoKRsj7hBrY2RB88yICFXabxUfDEudNRiRyao28GJUhZfF1~819JeWFPNuwAl06NWsqBh3zb33nifmt7gJCBXuLCyVAxnwIMgSLejEdBK2KpBPuzoK9iWbe1PWm4yYqeDCfy0foUY8wk9xuhG2m6Iu1QoTl7fUKXkRVKhqGQWLszfxdYBRVBxca-2S3Q92LCx16krS-JpSqq9CWrinPq1BbCpXhWmjuLzI5dMBPabFUaJVJksnaRMUSnDjJ-pnNjzrKa5cXWUVWPQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA", "https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f3.png?Expires=2147483647&Signature=J-J9iK-6CD5OnoyAyMGjRfdNAKn7rb3ZO1Enl9I97Nu3Led1TQRMzw2whZCsLCTu7ynSDG2So7XHGTP-wnLIq2bhVJ-Ip-nJIiDxneTQ1AhIk3akBYwNyHyiuLhKpicDpf8Oy19sIrmKspQ1tuOn4MjdvaHJ5QlDAY~wS--vBoTG3GAHdINP9~7bb44HK4NaUH8KE2FoTyJvPbB-hl6uSp3k0Bcpwn8lhEDN2kpe8geQabvo6T3bfrDUnJ6nUF4YySuhKALU1DrHD~-sbrorMdgtNApULzGjBSJ7~btSvS4HwMuBJaGRONH3AcZeLcqrxprSnUa3kK2cWiPtx6Rdng__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" ], "articleSection": [ "Methods", "Design and Participants", "Data Sources", "Determining Exposure Status", "Study Outcome", "Statistical Analyses", "Results", "Table 1. Characteristics of Hospitalized Patients by Group", "Need for Chronic Dialysis", "Table 2. Risk of Chronic Dialysis and All-Cause Mortality by Group", "All-Cause Mortality", "Unmatched Participants", "Comment" ], "keyWords": "hemodialysis, kidney failure, acute, dialysis procedure, survivors, kidney failure, chronic, patient discharge" } </script> <meta name="citation_author" content="Ron Wald" /><meta name="citation_author" content="Robert R. Quinn" /><meta name="citation_author" content="Jin Luo" /><meta name="citation_author" content="Ping Li" /><meta name="citation_author" content="Damon C. Scales" /><meta name="citation_author" content="Muhammad M. Mamdani" /><meta name="citation_author" content="Joel G. Ray" /><meta name="citation_author" content="for the University of Toronto Acute Kidney Injury Research Group" /><meta name="citation_title" content="Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis" /><meta name="citation_firstpage" content="1179" /><meta name="citation_lastpage" content="1185" /><meta name="citation_doi" content="10.1001/jama.2009.1322" /><meta name="citation_keyword" content="hemodialysis" /><meta name="citation_keyword" content="renal failure, acute" /><meta name="citation_keyword" content="dialysis procedure" /><meta name="citation_keyword" content="survivors" /><meta name="citation_keyword" content="kidney failure, chronic" /><meta name="citation_keyword" content="patient discharge" /><meta name="citation_abstract" content="<h3>Context</h3>Severe acute kidney injury among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who survive to hospital discharge.<h3>Objective</h3>To assess the risk of chronic dialysis and all-cause mortality in individuals who experience an episode of acute kidney injury requiring dialysis.<h3>Design, Setting, and Participants</h3>We conducted a population-based cohort study of all adult patients in Ontario, Canada, with acute kidney injury who required in-hospital dialysis and survived free of dialysis for at least 30 days after discharge between July 1, 1996, and December 31, 2006. These individuals were matched with patients without acute kidney injury or dialysis during their index hospitalization. Matching was by age plus or minus 5 years, sex, history of chronic kidney disease, receipt of mechanical ventilation during the index hospitalization, and a propensity score for developing acute kidney injury requiring dialysis. Patients were followed up until March 31, 2007.<h3>Main Outcome Measures</h3>The primary end point was the need for chronic dialysis and the secondary outcome was all-cause mortality.<h3>Results</h3>We identified 3769 adults with acute kidney injury requiring in-hospital dialysis and 13 598 matched controls. The mean age was 62 years and median follow-up was 3 years. The incidence rate of chronic dialysis was 2.63 per 100 person-years among individuals with acute kidney injury requiring dialysis, and 0.91 per 100 person-years among control participants (adjusted hazard ratio, 3.23; 95% confidence interval, 2.70-3.86). All-cause mortality rates were 10.10 and 10.85 per 100 person-years, respectively (adjusted hazard ratio, 0.95; 95% confidence interval, 0.89-1.02).<h3>Conclusions</h3>Acute kidney injury necessitating in-hospital dialysis was associated with an increased risk of chronic dialysis but not all-cause mortality." /><meta name="citation_journal_title" content="JAMA" /><meta name="citation_journal_abbrev" content="JAMA" /><meta name="citation_volume" content="302" /><meta name="citation_issue" content="11" /><meta name="citation_publication_date" content="2009/09/16" /><meta name="citation_issn" content="0098-7484" /><meta name="citation_publisher" content="American Medical Association" /><meta name="citation_reference" content="citation_org=French Study Group on Acute Renal Failure; citation_title=Acute renal failure in intensive care units–causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study: French Study Group on Acute Renal Failure.; citation_authors=Brivet FG; Kleinknecht DJ; Loirat P; Landais PJ; citation_journal_title=Crit Care Med; citation_year=1996; citation_volume=24; citation_issue=2; citation_pages=192-198; " /><meta name="citation_reference" content="citation_title=Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score.; citation_authors=de Mendonça A; Vincent JL; Suter PM; citation_journal_title=Intensive Care Med; citation_year=2000; citation_volume=26; citation_issue=7; citation_pages=915-921; " /><meta name="citation_reference" content="citation_title=Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.; citation_authors=Chertow GM; Burdick E; Honour M; Bonventre JV; Bates DW; citation_journal_title=J Am Soc Nephrol; citation_year=2005; citation_volume=16; citation_issue=11; citation_pages=3365-3370; " /><meta name="citation_reference" content="citation_title=Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey.; citation_authors=Liangos O; Wald R; O’Bell J; Price L; Pereira B; Jaber B; citation_journal_title=Clin J Am Soc Nephrol; citation_year=2006; citation_volume=1; citation_issue=1; citation_pages=43-51; " /><meta name="citation_reference" content="citation_title=Prognosis of patients with acute renal failure in the intensive-care unit: a tale of two eras.; citation_author=McCarthy JT; citation_journal_title=Mayo Clin Proc; citation_year=1996; citation_volume=71; citation_issue=2; citation_pages=117-126; " /><meta name="citation_reference" content="citation_title=Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia.; citation_authors=Silvester W; Bellomo R; Cole L; citation_journal_title=Crit Care Med; citation_year=2001; citation_volume=29; citation_issue=10; citation_pages=1910-1915; " /><meta name="citation_reference" content="citation_title=Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients.; citation_authors=Metnitz PG; Krenn CG; Steltzer H; citation_journal_title=Crit Care Med; citation_year=2002; citation_volume=30; citation_issue=9; citation_pages=2051-2058; " /><meta name="citation_reference" content="citation_title=Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies.; citation_authors=Morgera S; Kraft AK; Siebert G; Luft FC; Neumayer HH; citation_journal_title=Am J Kidney Dis; citation_year=2002; citation_volume=40; citation_issue=2; citation_pages=275-279; " /><meta name="citation_reference" content="citation_org=Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators; citation_title=Acute renal failure in critically ill patients: a multinational, multicenter study.; citation_authors=Uchino S; Kellum JA; Bellomo R; citation_journal_title=JAMA; citation_year=2005; citation_volume=294; citation_issue=7; citation_pages=813-818; " /><meta name="citation_reference" content="citation_title=Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients.; citation_author=Schiffl H; citation_journal_title=Nephrol Dial Transplant; citation_year=2006; citation_volume=21; citation_issue=5; citation_pages=1248-1252; " /><meta name="citation_reference" content="citation_org=Program to Improve Care in Acute Renal Disease; citation_title=Spectrum of acute renal failure in the intensive care unit: the PICARD experience.; citation_authors=Mehta RL; Pascual MT; Soroko S; citation_journal_title=Kidney Int; citation_year=2004; citation_volume=66; citation_issue=4; citation_pages=1613-1621; " /><meta name="citation_reference" content="citation_org=VA/NIH Acute Renal Failure Trial Network; citation_title=Intensity of renal support in critically ill patients with acute kidney injury.; citation_authors=Palevsky PM; Zhang JH; O'Connor TZ; citation_journal_title=N Engl J Med; citation_year=2008; citation_volume=359; citation_issue=1; citation_pages=7-20; " /><meta name="citation_reference" content="citation_title=Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study.; citation_authors=Bagshaw SM; Laupland KB; Doig CJ; citation_journal_title=Crit Care; citation_year=2005; citation_volume=9; citation_issue=6; citation_pages=R700-R709; " /><meta name="citation_reference" content="citation_title=Five-year outcomes of severe acute kidney injury requiring renal replacement therapy.; citation_authors=Schiffl H; Fischer R; citation_journal_title=Nephrol Dial Transplant; citation_year=2008; citation_volume=23; citation_issue=7; citation_pages=2235-2241; " /><meta name="citation_reference" content="citation_title=Survival and quality of life of patients requiring acute renal replacement therapy.; citation_authors=Ahlström A; Tallgren M; Peltonen S; Rasanen P; Pettila V; citation_journal_title=Intensive Care Med; citation_year=2005; citation_volume=31; citation_issue=9; citation_pages=1222-1228; " /><meta name="citation_reference" content="citation_title=Administrative data accurately identified intensive care unit admissions in Ontario.; citation_authors=Scales DC; Guan J; Martin CM; Redelmeier DA; citation_journal_title=J Clin Epidemiol; citation_year=2006; citation_volume=59; citation_issue=8; citation_pages=802-807; " /><meta name="citation_reference" content="citation_title=Estimating causal effects from large data sets using propensity scores.; citation_author=Rubin DB; citation_journal_title=Ann Intern Med; citation_year=1997; citation_volume=127; citation_issue=8 pt 2; citation_pages=757-763; " /><meta name="citation_reference" content="citation_title=A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.; citation_authors=Charlson ME; Pompei P; Ales KL; MacKenzie CR; citation_journal_title=J Chronic Dis; citation_year=1987; citation_volume=40; citation_issue=5; citation_pages=373-383; " /><meta name="citation_reference" content="citation_title=Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study.; citation_authors=Juurlink DN; Mamdani MM; Lee DS; citation_journal_title=N Engl J Med; citation_year=2004; citation_volume=351; citation_issue=6; citation_pages=543-551; " /><meta name="citation_reference" content="citation_title=Beta blockers for elective surgery in elderly patients: population based, retrospective cohort study.; citation_authors=Redelmeier D; Scales D; Kopp A; citation_journal_title=BMJ; citation_year=2005; citation_volume=331; citation_issue=7522; citation_pages=932" /><meta name="citation_reference" content="citation_title=Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure.; citation_authors=Waikar SS; Wald R; Chertow GM; citation_journal_title=J Am Soc Nephrol; citation_year=2006; citation_volume=17; citation_issue=6; citation_pages=1688-1694; " /><meta name="citation_reference" content="citation_title=Acute kidney injury increases risk of ESRD among elderly.; citation_authors=Ishani A; Xue JL; Himmelfarb J; citation_journal_title=J Am Soc Nephrol; citation_year=2009; citation_volume=20; citation_issue=1; citation_pages=223-228; " /><meta name="citation_reference" content="citation_title=Renal ischemic injury results in permanent damage to peritubular capillaries and influences long-term function.; citation_authors=Basile DP; Donohoe D; Roethe K; Osborn JL; citation_journal_title=Am J Physiol Renal Physiol; citation_year=2001; citation_volume=281; citation_issue=5; citation_pages=F887-F899; " /><meta name="citation_reference" content="citation_title=Transforming growth factor-beta in acute renal failure: receptor expression, effects on proliferation, cellularity, and vascularization after recovery from injury.; citation_authors=Spurgeon KR; Donohoe DL; Basile DP; citation_journal_title=Am J Physiol Renal Physiol; citation_year=2005; citation_volume=288; citation_issue=3; citation_pages=F568-F577; " /><meta name="citation_reference" content="citation_title=Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox.; citation_authors=Ko DT; Mamdani M; Alter DA; citation_journal_title=JAMA; citation_year=2004; citation_volume=291; citation_issue=15; citation_pages=1864-1870; " /><meta name="citation_fulltext_world_readable" content="" /><meta name="citation_pdf_url" content="https://jamanetwork.com/journals/jama/articlepdf/184587/joc90093_1179_1185.pdf" /> <title>Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis | Acute Kidney Injury | JAMA | JAMA Network</title> <meta name="description" content="ContextSevere acute kidney injury among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term"> <link rel="canonical" href="https://jamanetwork.com/journals/jama/fullarticle/184587" /> <script src="//cdn.jamanetwork.com/UI/app/dist/head.min.js?v=638677764511843155"></script> <script src="https://r451.jamanetwork.com/script.js" defer></script> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_HeaderScript"> <meta class="SCM-SharedWidgets-AsyncHeaderAdLoader" data-url="/AMA/AdTag/AMA_AdTag_HeaderScript" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":0,"adSection":"scholarly","adPosition":"","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"> </div> </head> <body data-sitename="jama" class="pg_article " data-thm="jama"> <script> var App = App || {}; App.suppressAds = App.suppressAds || !!document.getElementsByClassName('suppress-ads').length; App.suppressGtm = App.suppressGtm || !!document.getElementsByClassName('suppress-gtm').length; </script> <div id="ad-interstitial" class="ad-interstitial"> <script defer> googletag.cmd.push(function() { if (App.suppressAds) { return; } // Define a web interstitial ad slot. let interstitialSlot = googletag.defineOutOfPageSlot( App.Ads.adPath + '/scholarly', googletag.enums.OutOfPageFormat.INTERSTITIAL, ); if (interstitialSlot) { App.Ads.slots[13] = interstitialSlot; // Enable optional interstitial triggers and register the slot. interstitialSlot .setTargeting('pos', ['interstitial']) .addService(googletag.pubads()) .setConfig({ interstitial: { triggers: { navBar: true, unhideWindow: true, }, }, }); googletag.display(interstitialSlot); googletag.pubads().refresh([interstitialSlot], { changeCorrelator: false }); googletag.enableServices(); } }); </script> </div> <a class="accessible js-skip-to-navigation" href="#skip-to-navigation">[Skip to Navigation]</a> <noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-WNKSNP" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-WNKSNP');</script> <span class="hide tagmanagervalue" data-attribute="productName" data-value="JAMA" data-type="string"></span> <form method="post" action="./184587" id="webform" class="m0"> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="CBCkoR3pFwnxONpDJCDWp10mtYmt0LensrfYcJUdlyJCSr6riNuYU7vAlchpXQFNoDyPTwiBn5g30L0VaiFgkPnxPK8=" /> </div> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="2173C2F0" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="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" /> </div> <input id="hdnSiteID" type="hidden" value="3" /> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <section class="master-header"> <script type='text/javascript'> var App = App || {}; App.LoginUserInfo = { isInstLoggedIn: [0], currentSessionId: 'n0ecghh2tcc4digbyzauecdl' }; </script> <input name="ctl00$ctl00$BodyContent$Header$hfGlobalSearchSiteURL" type="hidden" id="hfGlobalSearchSiteURL" value="https://jamanetwork.com/" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsPaidUser" type="hidden" id="hfAppIsPaidUser" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsMember" type="hidden" id="hfAppIsMember" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppSubscribedTo" type="hidden" id="hfAppSubscribedTo" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsIndividual" type="hidden" id="hfAppIsIndividual" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppHasAccess" type="hidden" id="hfAppHasAccess" value="false" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsReferredFromGoogle" type="hidden" id="hfAppIsReferredFromGoogle" value="False" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrAutoSuggestMinimumCharactersLength" type="hidden" id="hfSolrAutoSuggestMinimumCharactersLength" value="2" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalName" type="hidden" id="hfSolrJournalName" value="JAMA" /> <input name="ctl00$ctl00$BodyContent$Header$hfSolrJournalID" type="hidden" id="hfSolrJournalID" value="J67" /> <input name="ctl00$ctl00$BodyContent$Header$hfAppIsLucy" type="hidden" id="hfAppIsLucy" value="false" /> <div class="header-wrap"> <header class="header"> <div class="widget-GdprCookieBanner widget-instance-GdprCookieBanner"> <div class="gdpr-cookie-wrapper js-gdpr-banner"> <div class="gdpr-cookie-body"> Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our <a href="https://jamanetwork.com/pages/privacy-policy#cookies">Cookie Policy</a> <span class="pipe">|</span> <a href="javascript:;" class="js-gdpr-cookie-acceptLink at-acceptgdpr">Continue</a> </div> <input id="hdnDomain" type="hidden" value=".jamanetwork.com" /> <input id="hdnDomainGdpr" type="hidden" value=".jamanetwork.com" /> <input id="hdnClientIdGdpr" type="hidden" value="3" /> </div> </div> <div class="network-bar"> <a class="jama-network" href="/" title="JAMA Network Home"> <img alt="JAMA Network Home" class="title-image" width="443" height="52" src="//cdn.jamanetwork.com/UI/app/svg/Jama_Network_Logo.svg"> </a> </div> <a class="nav-toggler" href="#nav"> <div class="nav-toggler-indicator"> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> <span class="indicator-stroke"></span> </div> <div class="nav-toggler-site"> <span id="BodyContent_Header_siteFullNamenav" class="nav-toggler-microsite"><span class='network'>JAMA</span></span> </div> </a> <nav id="nav" class="nav hide" > <div class="nav-journal-level sb-nav-journal-level"> <a href="https://jamanetwork.com/journals/jama" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_0" class="home">Home</a><a href="https://jamanetwork.com/journals/jama/newonline" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_1" class="new-online">New Online</a><a href="https://jamanetwork.com/journals/jama/currentissue" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_2" class="current-issue">Current Issue</a><a href="https://jamanetwork.com/journals/jama/pages/for-authors" id="BodyContent_Header_rptMicrositeHeaders_aItemResourceList_3" class="for-authors">For Authors</a> </div> <div class="nav-journals"> <div class="widget-SelfServeContent widget-instance-HamburgerPublicationMenu"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="HamburgerPublicationMenu" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .nav-journals {margin-bottom: 1em;} .nav-heading {color: #B9B9B9;border-bottom: 0;border-top: 1px solid #242424;font-size: 1.15em;font-weight: 400;margin: 0;padding: .7em .75em .25em;text-transform: uppercase;} a.no-bullet:before {content:none !important;} .nav-heading {font-size: 1.15em;margin-bottom:0;padding-left: 38px;} /* .nav-journals a.theme-jama {background-color: #242424;border-bottom: 1px solid #fff;border-top: 1px solid #fff;color: #fff;font-size: 1.15em;margin-bottom: 8px;padding: 11px 0 9px 37px;} .nav-journals a.theme-jama::before {background: unset;content: "\e91b";display: none;font-family: ama_icons !important;font-size: 1.25em;line-height: 1;} .nav-journals a.theme-jama-network-open {border-bottom:0;} */ .nav .widget-instance-HamburgerPublicationMenu a {padding-left: 36px;} .fake-ribbon {border-left: 8px solid #BE1E32;} .fake-ribbon a:before {content:none;} .nav .widget-instance-HamburgerPublicationMenu .fake-ribbon a {padding-left:30px;} .nav-journals a.theme-plus:before {background:#d71635;} .nav-journals a.theme-jama-network-open {border-bottom:0;} </style> <h2 class="nav-heading">JAMA+</h2> <a href="/channels/ai" class="theme-plus">AI</a> <h2 class="nav-heading">Journals</h2> <a href="/journals/jama" class="theme-jama">JAMA</a> <a href="/journals/jamanetworkopen" class="theme-jama-network-open">JAMA Network Open</a> <a href="/journals/jamacardiology" class="theme-jama-cardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology" class="theme-jama-dermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum" class="theme-jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine" class="theme-jama-internal-medicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology" class="theme-jama-neurology">JAMA Neurology</a> <a href="/journals/jamaoncology" class="theme-jama-oncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology" class="theme-jama-ophthalmology">JAMA Ophthalmology </a> <a href="/journals/jamaotolaryngology" class="theme-jama-otolaryngology-head-neck-surgery">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics" class="theme-jama-pediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry" class="theme-jama-psychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery" class="theme-jama-surgery">JAMA Surgery</a> <a href="/journals/archneurpsyc" class="theme-archives-of-neurology-psychiatry-1919-1959-">Archives of Neurology & Psychiatry (1919-1959)</a> <h2 class="nav-heading">Podcasts</h2> <a href="/journals/jama/pages/jama-clinical-reviews">Clinical Reviews</a> <a href="/journals/jama/pages/jama-editors-summary">Editors' Summary</a> <a href="/journals/jama/pages/jama-medical-news">Medical News</a> <a href="/journals/jama/pages/jama-author-interviews">Author Interviews</a> <a href="/pages/audio" class="no-bullet">More</a> </div> </div> </div> <div class="nav-network-other"> <a href="https://edhub.ama-assn.org/jn-learning" id="BodyContent_Header_rptOtherResources_aItemResourceList_0" class="is-b link-jn-learning-cme" target="_blank">JN Learning / CME</a><a href="https://store.jamanetwork.com/index.aspx?productcode=64" id="BodyContent_Header_rptOtherResources_aItemResourceList_1" class="is-b link-subscribe" target="_blank">Subscribe</a><a href="https://careers.jamanetwork.com/" id="BodyContent_Header_rptOtherResources_aItemResourceList_2" class="is-b link-jobs" target="_blank">Jobs</a><a href="https://jamanetwork.com/pages/resources-for-librarians" id="BodyContent_Header_rptOtherResources_aItemResourceList_3" class="is-b link-institutions-librarians">Institutions / Librarians</a><a href="https://jamanetwork.com/pages/reprints-and-permissions" id="BodyContent_Header_rptOtherResources_aItemResourceList_4" class="is-b link-reprints-permissions" rel="nofollow">Reprints & Permissions</a> </div> <div class="white text-xxs"> <div class="p05 ml4 mr3 mb1 mt10 flex hamburger-menu-legal"> <a href="/pages/conditions-of-use" class="p0" rel="nofollow">Terms of Use</a> <span class="pl1 pr1">| </span> <a href="/pages/privacy-policy" class="p0" rel="nofollow">Privacy Policy</a> <span class="pl1 pr1">| </span> <a href="/pages/accessibility-statement" class="p0" rel="nofollow">Accessibility Statement</a> </div> <div class="ta-c"> <span class="pb1">2024 American Medical Association. All Rights Reserved</span> </div> </div> </nav> <a class="toolbar-search-trigger is-b" data-mobile-tog-target=".site-search"></a> <div id="site-search" role="search" class="site-search"> <div class="site-search-bar"> <div role="search"> <select name="ctl00$ctl00$BodyContent$Header$ddlForSearch" id="BodyContent_Header_ddlForSearch" Name="dropDownList" class="cs-select cs-skin-border" title="Search Site Selector" role="options" aria-labelledby="searchLabel"> <option value="J*">Search All</option> <option value="3">JAMA</option> <option value="214">JAMA Network Open</option> <option value="192">JAMA Cardiology</option> <option value="12">JAMA Dermatology</option> <option value="261">JAMA Forum Archive</option> <option value="193">JAMA Health Forum</option> <option value="15">JAMA Internal Medicine</option> <option value="16">JAMA Neurology</option> <option value="159">JAMA Oncology</option> <option value="17">JAMA Ophthalmology</option> <option value="18">JAMA Otolaryngology–Head & Neck Surgery</option> <option value="19">JAMA Pediatrics</option> <option value="14">JAMA Psychiatry</option> <option value="20">JAMA Surgery</option> <option value="23">Archives of Neurology & Psychiatry</option> </select> </div> <div class="search-input-container"> <input type="search" name="textbox" autocomplete="off" role="textbox" id="search-term" aria-labelledby="searchLabel" class="search-term at-microsite-search-term" placeholder="Enter Search Term" maxlength="255" title="Enter Search Term"> <ul id="umbrellaSiteAutoCompleteResults" class="term-list hidden"></ul> <label style="display:none" for="umbrellaSiteSearchInputHint" id="searchLabel">Input Search Term</label> <input class="searchTerm search-input" name="textbox" role="textbox" type="text" id="umbrellaSiteSearchInputHint" aria-labelledby="searchLabel" title="Input Search Term" autocomplete="off"> </div>  <a name="button" role="button" class="search-button is-b js-search-button" alt="search button" href="/searchresults"></a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_auth" class="auth"> <a class="auth--trigger is-b is-a" href="javascript:;"> <span id="BodyContent_Header_GlobalSignIn_spnUserFullName" class="user-full-name">Sign In</span> </a> <div class="auth--dropdown js-signIn-dropdown"> <div class="auth--option auth--ind"> <div id="BodyContent_Header_GlobalSignIn_divUserFullName" class="auth--ind-user"></div> <div id="BodyContent_Header_GlobalSignIn_divIndSignIn" class="auth--ind-auth"> <div class="auth--title">Individual Sign In</div> <a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587" id="BodyContent_Header_GlobalSignIn_oauthSignInLink" rel="nofollow" class="auth--ind-sign-in">Sign in</a><a href="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587" id="BodyContent_Header_GlobalSignIn_oauthSignUpLink" rel="nofollow" class="auth--ind-create">Create an Account</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divInstSignIn" class="auth--option auth--inst"> <div class="auth--inst-auth"> <div class="auth--title">Access through your institution</div> <a href="/signinshibboleth?returnUrl=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587" id="BodyContent_Header_GlobalSignIn_institutionSignIn" rel="nofollow" class="auth--shib">Sign In</a> </div> </div> <div id="BodyContent_Header_GlobalSignIn_divPurchaseOptions" class="auth--option auth--purchase"> <div class="auth--title">Purchase Options:</div> <a id="BodyContent_Header_GlobalSignIn_lnkSubscribeJournal" class="auth--subscribe" rel="nofollow" href="https://store.jamanetwork.com/index.aspx?productcode=64">Subscribe to the JAMA journal</a> </div> </div> </div> </header> </div> <div class="editors-choice-header"> </div> <div id="BodyContent_Header_divAds" class="header-ad-wrap sb-background-primary-dark"> <div class="leader-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_LeaderboardAd"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_LeaderboardAd" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":1,"adSection":"scholarly","adPosition":"atf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div>  </section> <section class="master-main"> <div class="social-share hide" data-share-journal="JAMA_current" data-share-title="Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis"></div> <div class="widget-UserContentAccessWrite widget-instance-AMA_LocalStorage_Article"> <div class="SCM-SharedWidgets-LocalStorage-UserContentAccessWrite" data-values='{"id":"184587","type":"Article","date":"11/27/2024 12:05:47 AM"}'></div> </div> <div class="widget-ArticleToggleView widget-instance-AMA_ArticleToggleView"> <div class="widget-ArticleFullView widget-instance-AMA_ArticleFullView"> <script> (function () { var bodyElem = document.querySelector('body'); var className = 'split-screen'; if (bodyElem.classList) { bodyElem.classList.add(className); } else { el.className += ' ' + className; } })(); </script> <div id="resources-panel" class="resources-panel"> <span class="hide tagmanagervalue" data-attribute="template" data-value="splitscreen" data-type="string"></span> <div class="tab-nav"> <a class="tab-nav-trigger tab-nav-full-text tablet-down" href="#full-text-tab"> <i class="icon-full_text"><span class="sr-t">full text icon</span></i> <div class="tab-nav-tab-name">Full Text</div> </a> <a class="tab-nav-trigger tab-nav-contents target-tab-active" href="#contents-tab"> <i class="icon-contents"><span class="sr-t">contents icon</span></i> <div class="tab-nav-tab-name">Contents</div> </a> <a class="tab-nav-trigger tab-nav-figure-table" href="#figure-table-tab"> <i class="icon-figures"><span class="sr-t">figure icon</span></i> <div class="tab-nav-tab-name">Figures / <br> Tables</div> </a> <a class="tab-nav-trigger tab-nav-multimedia" href="#multimedia-tab"> <i class="icon-multimedia"><span class="sr-t">multimedia icon</span></i> <div class="tab-nav-tab-name">Multimedia</div> </a> <a class="tab-nav-trigger tab-nav-supplemental" href="#supplemental-tab"> <i class="icon-attach"><span class="sr-t">attach icon</span></i> <div class="tab-nav-tab-name">Supplemental <br> Content</div> </a> <a class="tab-nav-trigger tab-nav-references" href="#references-tab"> <i class="icon-references"><span class="sr-t">references icon</span></i> <div class="tab-nav-tab-name">References</div> </a> <a class="tab-nav-trigger tab-nav-related" href="#related-tab"> <i class="icon-related"><span class="sr-t">related icon</span></i> <div class="tab-nav-tab-name">Related</div> </a> <a class="tab-nav-trigger tab-nav-comments" href="#comments-tab"> <i class="icon-user-comments"><span class="sr-t">comments icon</span></i> <div class="tab-nav-tab-name">Comments</div> </a> </div> <div class="resource-tabs"> <div id="contents-tab" class="resource-tab js-resource-tab contents-tab tab-active"> <div class="contents-tab-contents"> <a id="pdf-link" href="/journals/jama/articlepdf/184587/joc90093_1179_1185.pdf" class="toolbar-tool toolbar-pdf al-link pdfaccess js-pdfaccess" data-article-id="184587" data-article-url="/journals/jama/articlepdf/184587/joc90093_1179_1185.pdf" data-ajax-url="/Content/CheckPdfAccess"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span> </a> <div class="widget-ArticleJumpLinks widget-instance-AMA_ArticleJumpLinks_Widget"> <a href="#top" class="section-jump-link contents-tab-jump-link top-of-article" data-tab-toggle=".tab-nav-full-text">Top of Article</a> <ul class="section-jump-links bullet ml2 pl1"> <li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#24832838" data-tab-toggle=".tab-nav-full-text">Abstract</a></li> <li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#24832842" data-tab-toggle=".tab-nav-full-text">Methods</a></li> <li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#24832863" data-tab-toggle=".tab-nav-full-text">Results</a></li> <li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#24832878" data-tab-toggle=".tab-nav-full-text">Comment</a></li> <li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#24832888" data-tab-toggle=".tab-nav-full-text">Article Information</a></li> <li><a class="section-jump-link contents-tab-jump-link scroll-to head-1" href="#24832889" data-tab-toggle=".tab-nav-full-text">References</a></li> </ul> </div> <div class="widget-SelfServeContent widget-instance-AMA_Contents_Tab_SelfServe"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="v2_article_content_tab" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="bc_rr_theme_promo"></div> <div class="bc_right_rail_article_promo"></div> </div> </div> </div> <div class="contents-tab-ad"> <div id="split-screen-contab"></div> </div> </div> <div id="figure-table-tab" class="resource-tab js-resource-tab figure-table-tab need-jobs-ad"> <div class="widget-ArticleFiguresAndTables widget-instance-AMA_Article_Figures_Tab"> <div class="figure-table-wrapper thm-bd-top"><div class="figure-label"><strong>Figure 1.</strong> Creation of the Acute Kidney Injury and Dialysis Study Cohort</div><a id="joc90093f1" class="figure-table-anchor"> </a><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="joc90093f1" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f1.png?Expires=1735237284&Signature=wx8AxtnIAAD88dbr84AO139LS62nS90NR~AglLCvrTnqjDDa84cOeklgICcGCFAwZctFqm3DQ-6wzCfaxP9u5TqrIl4muqyTNhEPU7SY3yUnUjSjsNQ~eeY83xkuLNNnUWotLJc-Xm1yvnjxP~PffOjoJvV-lluk9z4fhxENmCGnUyBt35628723uT9VKx0Nke7cyg~g0l27coUVXhhUSHkZu0piquuCWtUsbz6kaL8ed6SDFcNAs-ZhH3~lXXLLqmXTrPOhjDRJ4m3XaEcb8jeRPG6xX9vjxquXgTs0qNCIf1jP75OM0BEfzvvqU1Fjnb5pLFTuemYDrQAtzGILsA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="joc90093f1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f1.png?Expires=1735237284&Signature=wx8AxtnIAAD88dbr84AO139LS62nS90NR~AglLCvrTnqjDDa84cOeklgICcGCFAwZctFqm3DQ-6wzCfaxP9u5TqrIl4muqyTNhEPU7SY3yUnUjSjsNQ~eeY83xkuLNNnUWotLJc-Xm1yvnjxP~PffOjoJvV-lluk9z4fhxENmCGnUyBt35628723uT9VKx0Nke7cyg~g0l27coUVXhhUSHkZu0piquuCWtUsbz6kaL8ed6SDFcNAs-ZhH3~lXXLLqmXTrPOhjDRJ4m3XaEcb8jeRPG6xX9vjxquXgTs0qNCIf1jP75OM0BEfzvvqU1Fjnb5pLFTuemYDrQAtzGILsA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=24832865&ar=184587&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f1.png?Expires=1735237284&Signature=wx8AxtnIAAD88dbr84AO139LS62nS90NR~AglLCvrTnqjDDa84cOeklgICcGCFAwZctFqm3DQ-6wzCfaxP9u5TqrIl4muqyTNhEPU7SY3yUnUjSjsNQ~eeY83xkuLNNnUWotLJc-Xm1yvnjxP~PffOjoJvV-lluk9z4fhxENmCGnUyBt35628723uT9VKx0Nke7cyg~g0l27coUVXhhUSHkZu0piquuCWtUsbz6kaL8ed6SDFcNAs-ZhH3~lXXLLqmXTrPOhjDRJ4m3XaEcb8jeRPG6xX9vjxquXgTs0qNCIf1jP75OM0BEfzvvqU1Fjnb5pLFTuemYDrQAtzGILsA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joc90093f1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/m_joc90093f1.png?Expires=1735237284&Signature=msCcDB4zXzsFbvWCLUO~VUagXoLKUCNTJWsERnvZzcvPBeOuottnF9yTleTjIbEpuMc9q1G4AjZMA-uwkzUJ5X6jzOTFVURB1QV9oXPAWpr5MF4Lzyg~HYJKXPK6QAjy1Sa3yAIxVLSGDMxEznMqm2XNZd7SRuygkfKTtJYj3ASKsHDWafbxkJT2OAbUyU1dYpZv4WjRq3BFaDrl0VgXvOkEBDvFlvPG8T8beVK35B6I7yfoPESKDSgQa-pkHuFqaj7cFF9riXkJicBIm5TKDsqwFBXVb0YE~ej2cTdsmlKVAZ4cpxvPOUdTpQyEM6xuVxHdWVLw1cVU44~BTc91PQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Figure 1. Creation of the Acute Kidney Injury and Dialysis Study Cohort" class="content-img lazy" path-from-xml="joc90093f1" /></a></div></div></div><div class="figure-table-wrapper thm-bd-top"><div class="figure-label"><strong>Figure 2.</strong> Risk of Chronic Dialysis in Association With Acute Kidney Injury and Dialysis During Index Hospitalization</div><a id="joc90093f2" class="figure-table-anchor"> </a><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="joc90093f2" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f2.png?Expires=1735237284&Signature=PKh0KGExWwDHAaYViiM0w7ib7VdmsPg1Vc1~5sD78qQOxF9481Q9521YUQFe~Laa8XPaHfOyiOM7t-P8hGcHF~rjuPefyB~YmaNDwKwJEyzYwpFGU56XQ9nzTNIvlLlnBniqzYJL7uRrOYrpUgD75oTwDAyYhonZPhknMdkev8PSDh7aRlNRDDKNxuejx-UYyctC2IUELNtu0ELCsOoyH-dCxWv1bD8IU9m1lRDiPxHxme2WDz2Ap7d-ENjDG7DK9QysyPe7KEBhT2lvuKxN5Gw8I5c5OA1-yMqWCTP8fhUgrdyg-mZSfYdUks41W6J4XgSmHPVDc8HdQnWkDKqKkQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="joc90093f2" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f2.png?Expires=1735237284&Signature=PKh0KGExWwDHAaYViiM0w7ib7VdmsPg1Vc1~5sD78qQOxF9481Q9521YUQFe~Laa8XPaHfOyiOM7t-P8hGcHF~rjuPefyB~YmaNDwKwJEyzYwpFGU56XQ9nzTNIvlLlnBniqzYJL7uRrOYrpUgD75oTwDAyYhonZPhknMdkev8PSDh7aRlNRDDKNxuejx-UYyctC2IUELNtu0ELCsOoyH-dCxWv1bD8IU9m1lRDiPxHxme2WDz2Ap7d-ENjDG7DK9QysyPe7KEBhT2lvuKxN5Gw8I5c5OA1-yMqWCTP8fhUgrdyg-mZSfYdUks41W6J4XgSmHPVDc8HdQnWkDKqKkQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=24832871&ar=184587&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f2.png?Expires=1735237284&Signature=PKh0KGExWwDHAaYViiM0w7ib7VdmsPg1Vc1~5sD78qQOxF9481Q9521YUQFe~Laa8XPaHfOyiOM7t-P8hGcHF~rjuPefyB~YmaNDwKwJEyzYwpFGU56XQ9nzTNIvlLlnBniqzYJL7uRrOYrpUgD75oTwDAyYhonZPhknMdkev8PSDh7aRlNRDDKNxuejx-UYyctC2IUELNtu0ELCsOoyH-dCxWv1bD8IU9m1lRDiPxHxme2WDz2Ap7d-ENjDG7DK9QysyPe7KEBhT2lvuKxN5Gw8I5c5OA1-yMqWCTP8fhUgrdyg-mZSfYdUks41W6J4XgSmHPVDc8HdQnWkDKqKkQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joc90093f2" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/m_joc90093f2.png?Expires=1735237284&Signature=GdXTY5DCdpR40Gk5dQjSzh8YEwx5CWJM5QlHO~yRpbLKiwarGuqFgmLdVyAPbm5Tj~K81YYInDQC~XDPX13vU34E~3TfnToV~sRWh6QyexpjQS7ggQsB7urVeppFrbtYUWcF7RgGw5~4686kXgvZUsvwTcVYE7Z8lsFVfWlMATYKM7~QV6UlFMt-5H~Xx5L8ws9tLuuClHA2RiKYOmj5PzH3qcwVUp3qSTwx0wYiuykA5tSsAIjC4h6im2gdXdgRcbIfeRuBHC~M1bipbJQzG3IZtQ-sPtlk2HfCWFT7x2T9nl-Q8k8v71MaMK0nbBnLzKXBxCFxMhZsJFYFV0cjIQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Figure 2. Risk of Chronic Dialysis in Association With Acute Kidney Injury and Dialysis During Index Hospitalization" class="content-img lazy" path-from-xml="joc90093f2" /></a></div></div></div><div class="figure-table-wrapper thm-bd-top"><div class="figure-label"><strong>Figure 3.</strong> Risk of Chronic Dialysis Associated With Acute Kidney Injury and Dialysis at Index Hospitalization by Participant Characteristics</div><a id="joc90093f3" class="figure-table-anchor"> </a><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="joc90093f3" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f3.png?Expires=1735237284&Signature=kyiMXNjL4UWN9cMscyPhVNibJHykIdKaooaFSDJ6mkWjkn92EZduN7Rlj5-XCelhP~tLE8QN12SGmKHviAGbWwd~5~j0G7D2BVrvywxSfRqGyYeYCwmSjTwLc0HMYKcfjbW8JEgrK26yFmeJzC9JCgl3fVq9qLN5oV2uKA23sNhvyfNjuGRyyXAvOmQTqGVc4Z~6FcVTTe79~lsX7XgYfnRwHnr54tR7dJUHDo9XZfzmbKeyKt5j-iCL62UhM8hRAqTMC~-ygC3fzyf0VgOd0do8qku78uxqHOrbvy~2R9fpJtOHotGBH6fwIqI-y-HXlFdzyqbgXTpI0NHbKxZbxQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="joc90093f3" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f3.png?Expires=1735237284&Signature=kyiMXNjL4UWN9cMscyPhVNibJHykIdKaooaFSDJ6mkWjkn92EZduN7Rlj5-XCelhP~tLE8QN12SGmKHviAGbWwd~5~j0G7D2BVrvywxSfRqGyYeYCwmSjTwLc0HMYKcfjbW8JEgrK26yFmeJzC9JCgl3fVq9qLN5oV2uKA23sNhvyfNjuGRyyXAvOmQTqGVc4Z~6FcVTTe79~lsX7XgYfnRwHnr54tR7dJUHDo9XZfzmbKeyKt5j-iCL62UhM8hRAqTMC~-ygC3fzyf0VgOd0do8qku78uxqHOrbvy~2R9fpJtOHotGBH6fwIqI-y-HXlFdzyqbgXTpI0NHbKxZbxQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=24832873&ar=184587&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093f3.png?Expires=1735237284&Signature=kyiMXNjL4UWN9cMscyPhVNibJHykIdKaooaFSDJ6mkWjkn92EZduN7Rlj5-XCelhP~tLE8QN12SGmKHviAGbWwd~5~j0G7D2BVrvywxSfRqGyYeYCwmSjTwLc0HMYKcfjbW8JEgrK26yFmeJzC9JCgl3fVq9qLN5oV2uKA23sNhvyfNjuGRyyXAvOmQTqGVc4Z~6FcVTTe79~lsX7XgYfnRwHnr54tR7dJUHDo9XZfzmbKeyKt5j-iCL62UhM8hRAqTMC~-ygC3fzyf0VgOd0do8qku78uxqHOrbvy~2R9fpJtOHotGBH6fwIqI-y-HXlFdzyqbgXTpI0NHbKxZbxQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joc90093f3" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/m_joc90093f3.png?Expires=1735237284&Signature=1Tkm6f4d1e2OV34aY0XG60w0svP3rnY27~iteYdNwXJEFzUh~LJ6qvkW73iAZKnTsibI2WNE0UqRov5~MMdbWo2PlExFVNiz3Is1SS~Xwj1cvXp0y-G0L~fioSBvAc0dH6Dh4OAbAvqa00bxp1gmaXIWo64YtilrN5jH9NbnNtnrKUCtqS~6X15o7ABREd20K0kcyMMIowPRtvmXA1TGYMQ34u5k-D3q7ANWIAHr0xnTU0oI4~tvE-Xsn6Qxt~DOklV4uKD2uf9yxMrv4oZS6y1uJA3CEMqJ1~5A7Fo2b9mEyt50E6wgIJTud1KdLeFvjm4pZBb4EM2I5TlASwNBwQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Figure 3. Risk of Chronic Dialysis Associated With Acute Kidney Injury and Dialysis at Index Hospitalization by Participant Characteristics" class="content-img lazy" path-from-xml="joc90093f3" /></a></div></div><div class="figure-caption clip-last-child"><p class="para"><sup>a</sup>The numerator denotes the number of events (requirement for chronic dialysis) and the denominator denotes the number of patients at risk within that subgroup. <br />Hazard ratios are adjusted for the propensity score for acute kidney injury and dialysis and participant age. Effect estimates are not shown; models did not converge.</p></div></div> </div> <div class="widget-ArticleFiguresAndTables widget-instance-AMA_Article_Tables_Tab"> <div class="figure-table-wrapper thm-bd-top"><a id="joc90093t1" class="figure-table-anchor"> </a><div class="table-label"><strong>Table 1.</strong> Characteristics of Hospitalized Patients by Group</div><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="joc90093t1" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t1.png?Expires=1735237284&Signature=n9hUGYiUW15PQk6Thqo52CdG3tQHXyMaWcxGSd1FRSNogX8N1qvPbCNuFtxk2EQHhA68-ZlCvLyRorKMaizjT7LGSkKWizDmVWzAc3oBRSlECohMEbQqoN7I2DNAB3N3BjDQIgOG6Y3oY49W2E0UAcZNkzVZnkvNSX8kq1aLeQb0qLnjmKaHTHWzWS7raFyzMV2qXMDtyl1Epyt1E6r-Uv9BErGcI~hH8xkgHLXZ~7E~HTyCigJPrcLtLxT2sH~8DcoC88Ppk1up1w-5y6rO8j2mwKZ3anTg5MwBPYskFAyyfXhPkK8ujbWTanvdHRXwD7yo-n38PNbK8lnLIxx4Xw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="joc90093t1" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t1.png?Expires=1735237284&Signature=n9hUGYiUW15PQk6Thqo52CdG3tQHXyMaWcxGSd1FRSNogX8N1qvPbCNuFtxk2EQHhA68-ZlCvLyRorKMaizjT7LGSkKWizDmVWzAc3oBRSlECohMEbQqoN7I2DNAB3N3BjDQIgOG6Y3oY49W2E0UAcZNkzVZnkvNSX8kq1aLeQb0qLnjmKaHTHWzWS7raFyzMV2qXMDtyl1Epyt1E6r-Uv9BErGcI~hH8xkgHLXZ~7E~HTyCigJPrcLtLxT2sH~8DcoC88Ppk1up1w-5y6rO8j2mwKZ3anTg5MwBPYskFAyyfXhPkK8ujbWTanvdHRXwD7yo-n38PNbK8lnLIxx4Xw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=24832866&ar=184587&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t1.png?Expires=1735237284&Signature=n9hUGYiUW15PQk6Thqo52CdG3tQHXyMaWcxGSd1FRSNogX8N1qvPbCNuFtxk2EQHhA68-ZlCvLyRorKMaizjT7LGSkKWizDmVWzAc3oBRSlECohMEbQqoN7I2DNAB3N3BjDQIgOG6Y3oY49W2E0UAcZNkzVZnkvNSX8kq1aLeQb0qLnjmKaHTHWzWS7raFyzMV2qXMDtyl1Epyt1E6r-Uv9BErGcI~hH8xkgHLXZ~7E~HTyCigJPrcLtLxT2sH~8DcoC88Ppk1up1w-5y6rO8j2mwKZ3anTg5MwBPYskFAyyfXhPkK8ujbWTanvdHRXwD7yo-n38PNbK8lnLIxx4Xw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joc90093t1" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/m_joc90093t1.png?Expires=1735237284&Signature=rpo9IHOtjrZA8m81ug1fR~cq8XD9RbURk~UR2cLpz9FpqM3E2Ak5ilmDAkLSKzHkMelSSA5GLuZ-p8Kvhn4~WjYign7Tvwc6U5EM4rgDPe-3s6pO0vbqkuIoFNEUpOp1ujTKXix~bDabxpFaCKoe3WjzPGnUoveeVLSKIyo85B3Jb8TZOJa4EygypkQ-B8-aVv3oGrY1Skxseb0s6UWhSpcuy7EaJoVnpgH0Vv~ioHXpjpq3FPpxnKLL~gtGI5tqLZLvuSyUBWPAnBAf5xNH6UKUQwmgqaaQ-1C2VLLHqCayzBngVKr~Vp-SomdzF7fP~~Wcx3E43TEkJqK2JDKAwg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Table 1. Characteristics of Hospitalized Patients by Group" class="content-img lazy" path-from-xml="joc90093t1" /></a></div></div></div><div class="figure-table-wrapper thm-bd-top"><a id="joc90093t2" class="figure-table-anchor"> </a><div class="table-label"><strong>Table 2.</strong> Risk of Chronic Dialysis and All-Cause Mortality by Group</div><div class="figure-table-links right"><a class="view-large figure-table-link is-b desktop-only" path-from-xml="joc90093t2" href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t2.png?Expires=1735237284&Signature=RFFC8~ry~~yr8BQgavb70P1pUAyJHy~gas0zW7MvKUCO0UBv~Z4DvCaxMyKFVoOEUFSuSl3-g64-467FPWPisxiRQwNjRxIA0GQbayV4cbHGVtFdKBxUyGEYNcf8MZ1Vry53JwyMIX7I8HWwJ8i39KCzc8JsIQ0FDUQh~saGgrm4QBaF-FCkN0caRQhoRbvLlL8qgOpG9OH2grJjEXCbtAliJaHcpP05Ydf-P5XcOlyxGyRK3obppoKYiiqsAETYsIMbUa9uMbEdwlAC4hfBCW2RaWAMftrowZRsr~HNaAm4EW6huXv2HXsnsQiUxuG8FYDv~gmpWDeG5n~imVTghA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" rel="nofollow"><span class="view-large-text">View Large</span></a><a class="download-ppt figure-table-link is-b stats-download-figure-table" path-from-xml="joc90093t2" href="/downloadimage.aspx?image=https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t2.png?Expires=1735237284&Signature=RFFC8~ry~~yr8BQgavb70P1pUAyJHy~gas0zW7MvKUCO0UBv~Z4DvCaxMyKFVoOEUFSuSl3-g64-467FPWPisxiRQwNjRxIA0GQbayV4cbHGVtFdKBxUyGEYNcf8MZ1Vry53JwyMIX7I8HWwJ8i39KCzc8JsIQ0FDUQh~saGgrm4QBaF-FCkN0caRQhoRbvLlL8qgOpG9OH2grJjEXCbtAliJaHcpP05Ydf-P5XcOlyxGyRK3obppoKYiiqsAETYsIMbUa9uMbEdwlAC4hfBCW2RaWAMftrowZRsr~HNaAm4EW6huXv2HXsnsQiUxuG8FYDv~gmpWDeG5n~imVTghA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=24832870&ar=184587&imagename=&siteId=3" rel="nofollow"><span class="download-ppt-text">Download</span></a><a class="figure-table-twitter figure-table-link figure-table-social addthis_button_twitter is-b" rel="nofollow"><span class="share-text"> </span></a><a class="figure-table-facebook figure-table-link figure-table-social addthis_button_facebook is-b" rel="nofollow"><span class="share-text"> </span></a></div><div class="figure-table cf cb"><div class="figure-table-image"><a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/joc90093t2.png?Expires=1735237284&Signature=RFFC8~ry~~yr8BQgavb70P1pUAyJHy~gas0zW7MvKUCO0UBv~Z4DvCaxMyKFVoOEUFSuSl3-g64-467FPWPisxiRQwNjRxIA0GQbayV4cbHGVtFdKBxUyGEYNcf8MZ1Vry53JwyMIX7I8HWwJ8i39KCzc8JsIQ0FDUQh~saGgrm4QBaF-FCkN0caRQhoRbvLlL8qgOpG9OH2grJjEXCbtAliJaHcpP05Ydf-P5XcOlyxGyRK3obppoKYiiqsAETYsIMbUa9uMbEdwlAC4hfBCW2RaWAMftrowZRsr~HNaAm4EW6huXv2HXsnsQiUxuG8FYDv~gmpWDeG5n~imVTghA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" target="_blank" path-from-xml="joc90093t2" rel="nofollow"><img data-original="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/m_joc90093t2.png?Expires=1735237284&Signature=5MpWlvfxivS8CxI1-Q1nmtYWRYTY847EkoFLSI9ai4pFZjv6Ii2IW2OzR~rfKc8BkgUAONKDJZ-s0SI8XvXLmC1tVaIIRgSYzM43P~s~4NvBntg443pbGd8rvkOKbNWpgh2ZIxSVaX3f0mnDnTH~n8PiZMPA7xy3BMzieJlEBvPBauPGcg0o5ctt9NpCjbRAyl9M7BXebnoxvpQ9~3bBXFdZuEjdzTNUM7tTDvtSj6yOBShqIHzQN8vSrYzPYoCap4irYs-eXevSrYcq~NYzECwH~DLCx0cAMAj4-~IsBkIsbP~Fj4wvHODykkutahwSWBBfi8f13-oGouZBWoMnAQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Table 2. Risk of Chronic Dialysis and All-Cause Mortality by Group" class="content-img lazy" path-from-xml="joc90093t2" /></a></div></div></div> </div> </div> <div id="multimedia-tab" class="resource-tab js-resource-tab multimedia-tab need-jobs-ad"> </div> <div id="supplemental-tab" class="resource-tab js-resource-tab supplemental-tab need-jobs-ad"> <div class="widget-ArticleDataSupplements widget-instance-AMA_Data_Supplements_Tab"> <div class="supplement"> <a href="https://cdn.jamanetwork.com/ama/content_public/journal/jama/4480/jwe90032_9.16.09.pdf?Expires=1735664534&Signature=JT6oF78qLLoqGuY8tUy7d9K4FxV9SrqSs0Jq0VLCTnH1bOYXSTid-dgypfyFap5y4167vgn4~zDApN8zluEtdtHy86pNlzzag4SN13zwXJAQ3MQrLq50ZVRL91eJla4OivV0j9gFiywUdgpc9NtHuR3CqdpmE6XTZ7lYM8WgYE4kb5IA0rJXBUanGMU20CvWX~ENn2xqk2kR8qqi6wsg9xYbc6-H6yWMwVnFnb3dtWGyJLk2OVDFNspjUCEj5~8uEDiEBhPGvi0g18kS5u1kn49EIJ7zJFhAEuLAkR~gesOWLgCNsg3LYe8r45vpyYTr8sn0eiTvZuflshQMmQA4Ew__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" class="supplement-link supplement-download stats-supplement-download" rel="nofollow"> <div class="pdf supplement-type"></div> <div class="supplement-title">Data Supplement</div> </a> </div> </div> </div> <div id="references-tab" class="resource-tab js-resource-tab references-tab need-jobs-ad"> <div class="references-wrap"> <div class="widget-SectionDisplay widget-instance-AMA_References_Tab"> <div class="references"><div class="reference"><a class="reference-number" id="ref-joc90093-1">1.</a><div class="reference-content">Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ.French Study Group on Acute Renal Failure. Acute renal failure in intensive care units–causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study: French Study Group on Acute Renal Failure. <I xmlns:helper="urn:XsltStringHelper"> Crit Care Med</I>. 1996;24(2):192-1988605788<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8605788" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20renal%20failure%20in%20intensive%20care%20units%E2%80%93causes%2C%20outcome%2C%20and%20prognostic%20factors%20of%20hospital%20mortality%3B%20a%20prospective%2C%20multicenter%20study%3A%20French%20Study%20Group%20on%20Acute%20Renal%20Failure.&author=FG%20Brivet&author=DJ%20Kleinknecht&author=P%20Loirat&author=PJ%20Landais&publication_year=&journal=Crit%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00003246-199602000-00003" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00003246-199602000-00003" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-2">2.</a><div class="reference-content">de Mendonça A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. <I xmlns:helper="urn:XsltStringHelper"> Intensive Care Med</I>. 2000;26(7):915-92110990106<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/10990106" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20renal%20failure%20in%20the%20ICU%3A%20risk%20factors%20and%20outcome%20evaluated%20by%20the%20SOFA%20score.&author=A%20de Mendonça&author=JL%20Vincent&author=PM%20Suter&publication_year=&journal=Intensive%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s001340051281" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1007/s001340051281" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-3">3.</a><div class="reference-content">Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. <I xmlns:helper="urn:XsltStringHelper"> J Am Soc Nephrol</I>. 2005;16(11):3365-337016177006<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16177006" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20kidney%20injury%2C%20mortality%2C%20length%20of%20stay%2C%20and%20costs%20in%20hospitalized%20patients.&author=GM%20Chertow&author=E%20Burdick&author=M%20Honour&author=JV%20Bonventre&author=DW%20Bates&publication_year=&journal=J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1681/ASN.2004090740" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1681/ASN.2004090740" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-4">4.</a><div class="reference-content">Liangos O, Wald R, O’Bell J, Price L, Pereira B, Jaber B. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. <I xmlns:helper="urn:XsltStringHelper"> Clin J Am Soc Nephrol</I>. 2006;1(1):43-5117699189<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17699189" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Epidemiology%20and%20outcomes%20of%20acute%20renal%20failure%20in%20hospitalized%20patients%3A%20a%20national%20survey.&author=O%20Liangos&author=R%20Wald&author=J%20O’Bell&author=L%20Price&author=B%20Pereira&author=B%20Jaber&publication_year=&journal=Clin%20J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.2215/CJN.00220605" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.2215/CJN.00220605" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-5">5.</a><div class="reference-content">McCarthy JT. Prognosis of patients with acute renal failure in the intensive-care unit: a tale of two eras. <I xmlns:helper="urn:XsltStringHelper"> Mayo Clin Proc</I>. 1996;71(2):117-1268577185<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8577185" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prognosis%20of%20patients%20with%20acute%20renal%20failure%20in%20the%20intensive-care%20unit%3A%20a%20tale%20of%20two%20eras.&author=JT%20McCarthy&publication_year=&journal=Mayo%20Clin%20Proc&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.4065/71.2.117" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.4065/71.2.117" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-6">6.</a><div class="reference-content">Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. <I xmlns:helper="urn:XsltStringHelper"> Crit Care Med</I>. 2001;29(10):1910-191511588450<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/11588450" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Epidemiology%2C%20management%2C%20and%20outcome%20of%20severe%20acute%20renal%20failure%20of%20critical%20illness%20in%20Australia.&author=W%20Silvester&author=R%20Bellomo&author=L%20Cole&publication_year=&journal=Crit%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00003246-200110000-00010" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00003246-200110000-00010" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-7">7.</a><div class="reference-content">Metnitz PG, Krenn CG, Steltzer H, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. <I xmlns:helper="urn:XsltStringHelper"> Crit Care Med</I>. 2002;30(9):2051-205812352040<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12352040" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Effect%20of%20acute%20renal%20failure%20requiring%20renal%20replacement%20therapy%20on%20outcome%20in%20critically%20ill%20patients.&author=PG%20Metnitz&author=CG%20Krenn&author=H%20Steltzer&publication_year=&journal=Crit%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00003246-200209000-00016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00003246-200209000-00016" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-8">8.</a><div class="reference-content">Morgera S, Kraft AK, Siebert G, Luft FC, Neumayer HH. Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. <I xmlns:helper="urn:XsltStringHelper"> Am J Kidney Dis</I>. 2002;40(2):275-27912148099<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12148099" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Long-term%20outcomes%20in%20acute%20renal%20failure%20patients%20treated%20with%20continuous%20renal%20replacement%20therapies.&author=S%20Morgera&author=AK%20Kraft&author=G%20Siebert&author=FC%20Luft&author=HH%20Neumayer&publication_year=&journal=Am%20J%20Kidney%20Dis&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1053/ajkd.2002.34505" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1053/ajkd.2002.34505" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-9">9.</a><div class="reference-content">Uchino S, Kellum JA, Bellomo R, et al; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. <I xmlns:helper="urn:XsltStringHelper"> JAMA</I>. 2005;294(7):813-81816106006<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16106006" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20renal%20failure%20in%20critically%20ill%20patients%3A%20a%20multinational%2C%20multicenter%20study.&author=S%20Uchino&author=JA%20Kellum&author=R%20Bellomo&publication_year=&journal=JAMA&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.294.7.813" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jama.294.7.813" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-10">10.</a><div class="reference-content">Schiffl H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. <I xmlns:helper="urn:XsltStringHelper"> Nephrol Dial Transplant</I>. 2006;21(5):1248-125216449291<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16449291" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Renal%20recovery%20from%20acute%20tubular%20necrosis%20requiring%20renal%20replacement%20therapy%3A%20a%20prospective%20study%20in%20critically%20ill%20patients.&author=H%20Schiffl&publication_year=&journal=Nephrol%20Dial%20Transplant&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1093/ndt/gfk069" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1093/ndt/gfk069" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-11">11.</a><div class="reference-content">Mehta RL, Pascual MT, Soroko S, et al; Program to Improve Care in Acute Renal Disease. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. <I xmlns:helper="urn:XsltStringHelper"> Kidney Int</I>. 2004;66(4):1613-162115458458<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15458458" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Spectrum%20of%20acute%20renal%20failure%20in%20the%20intensive%20care%20unit%3A%20the%20PICARD%20experience.&author=RL%20Mehta&author=MT%20Pascual&author=S%20Soroko&publication_year=&journal=Kidney%20Int&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/j.1523-1755.2004.00927.x" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1111/j.1523-1755.2004.00927.x" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-12">12.</a><div class="reference-content">Palevsky PM, Zhang JH, O'Connor TZ, et al; VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. <I xmlns:helper="urn:XsltStringHelper"> N Engl J Med</I>. 2008;359(1):7-2018492867<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/18492867" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Intensity%20of%20renal%20support%20in%20critically%20ill%20patients%20with%20acute%20kidney%20injury.&author=PM%20Palevsky&author=JH%20Zhang&author=TZ%20O'Connor&publication_year=&journal=N%20Engl%20J%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa0802639" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1056/NEJMoa0802639" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-13">13.</a><div class="reference-content">Bagshaw SM, Laupland KB, Doig CJ, et al. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. <I xmlns:helper="urn:XsltStringHelper"> Crit Care</I>. 2005;9(6):R700-R70916280066<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16280066" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prognosis%20for%20long-term%20survival%20and%20renal%20recovery%20in%20critically%20ill%20patients%20with%20severe%20acute%20renal%20failure%3A%20a%20population-based%20study.&author=SM%20Bagshaw&author=KB%20Laupland&author=CJ%20Doig&publication_year=&journal=Crit%20Care&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1186/cc3879" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1186/cc3879" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-14">14.</a><div class="reference-content">Schiffl H, Fischer R. Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. <I xmlns:helper="urn:XsltStringHelper"> Nephrol Dial Transplant</I>. 2008;23(7):2235-224118408072<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/18408072" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Five-year%20outcomes%20of%20severe%20acute%20kidney%20injury%20requiring%20renal%20replacement%20therapy.&author=H%20Schiffl&author=R%20Fischer&publication_year=&journal=Nephrol%20Dial%20Transplant&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1093/ndt/gfn182" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1093/ndt/gfn182" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-15">15.</a><div class="reference-content">Ahlström A, Tallgren M, Peltonen S, Rasanen P, Pettila V. Survival and quality of life of patients requiring acute renal replacement therapy. <I xmlns:helper="urn:XsltStringHelper"> Intensive Care Med</I>. 2005;31(9):1222-122816049711<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16049711" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Survival%20and%20quality%20of%20life%20of%20patients%20requiring%20acute%20renal%20replacement%20therapy.&author=A%20Ahlström&author=M%20Tallgren&author=S%20Peltonen&author=P%20Rasanen&author=V%20Pettila&publication_year=&journal=Intensive%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s00134-005-2681-6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1007/s00134-005-2681-6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-16">16.</a><div class="reference-content">Scales DC, Guan J, Martin CM, Redelmeier DA. Administrative data accurately identified intensive care unit admissions in Ontario. <I xmlns:helper="urn:XsltStringHelper"> J Clin Epidemiol</I>. 2006;59(8):802-80716828673<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16828673" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Administrative%20data%20accurately%20identified%20intensive%20care%20unit%20admissions%20in%20Ontario.&author=DC%20Scales&author=J%20Guan&author=CM%20Martin&author=DA%20Redelmeier&publication_year=&journal=J%20Clin%20Epidemiol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jclinepi.2005.11.015" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.jclinepi.2005.11.015" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-17">17.</a><div class="reference-content">Rubin DB. Estimating causal effects from large data sets using propensity scores. <I xmlns:helper="urn:XsltStringHelper"> Ann Intern Med</I>. 1997;127(8 pt 2):757-7639382394<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/9382394" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimating%20causal%20effects%20from%20large%20data%20sets%20using%20propensity%20scores.&author=DB%20Rubin&publication_year=&journal=Ann%20Intern%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.7326/0003-4819-127-8_Part_2-199710151-00064" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.7326/0003-4819-127-8_Part_2-199710151-00064" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-18">18.</a><div class="reference-content">Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. <I xmlns:helper="urn:XsltStringHelper"> J Chronic Dis</I>. 1987;40(5):373-3833558716<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/3558716" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20new%20method%20of%20classifying%20prognostic%20comorbidity%20in%20longitudinal%20studies%3A%20development%20and%20validation.&author=ME%20Charlson&author=P%20Pompei&author=KL%20Ales&author=CR%20MacKenzie&publication_year=&journal=J%20Chronic%20Dis&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/0021-9681(87)90171-8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/0021-9681(87)90171-8" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-19">19.</a><div class="reference-content">Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. <I xmlns:helper="urn:XsltStringHelper"> N Engl J Med</I>. 2004;351(6):543-55115295047<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15295047" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Rates%20of%20hyperkalemia%20after%20publication%20of%20the%20Randomized%20Aldactone%20Evaluation%20Study.&author=DN%20Juurlink&author=MM%20Mamdani&author=DS%20Lee&publication_year=&journal=N%20Engl%20J%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa040135" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1056/NEJMoa040135" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-20">20.</a><div class="reference-content">Redelmeier D, Scales D, Kopp A. Beta blockers for elective surgery in elderly patients: population based, retrospective cohort study. <I xmlns:helper="urn:XsltStringHelper"> BMJ</I>. 2005;331(7522):93216210252<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16210252" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Beta%20blockers%20for%20elective%20surgery%20in%20elderly%20patients%3A%20population%20based%2C%20retrospective%20cohort%20study.&author=D%20Redelmeier&author=D%20Scales&author=A%20Kopp&publication_year=&journal=BMJ&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1136/bmj.38603.746944.3A" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1136/bmj.38603.746944.3A" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-21">21.</a><div class="reference-content">Waikar SS, Wald R, Chertow GM, et al. Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. <I xmlns:helper="urn:XsltStringHelper"> J Am Soc Nephrol</I>. 2006;17(6):1688-169416641149<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16641149" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Validity%20of%20International%20Classification%20of%20Diseases%2C%20Ninth%20Revision%2C%20Clinical%20Modification%20Codes%20for%20Acute%20Renal%20Failure.&author=SS%20Waikar&author=R%20Wald&author=GM%20Chertow&publication_year=&journal=J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1681/ASN.2006010073" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1681/ASN.2006010073" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-22">22.</a><div class="reference-content">Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of ESRD among elderly. <I xmlns:helper="urn:XsltStringHelper"> J Am Soc Nephrol</I>. 2009;20(1):223-22819020007<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19020007" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20kidney%20injury%20increases%20risk%20of%20ESRD%20among%20elderly.&author=A%20Ishani&author=JL%20Xue&author=J%20Himmelfarb&publication_year=&journal=J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1681/ASN.2007080837" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1681/ASN.2007080837" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-23">23.</a><div class="reference-content">Basile DP, Donohoe D, Roethe K, Osborn JL. Renal ischemic injury results in permanent damage to peritubular capillaries and influences long-term function. <I xmlns:helper="urn:XsltStringHelper"> Am J Physiol Renal Physiol</I>. 2001;281(5):F887-F89911592947<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/11592947" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Renal%20ischemic%20injury%20results%20in%20permanent%20damage%20to%20peritubular%20capillaries%20and%20influences%20long-term%20function.&author=DP%20Basile&author=D%20Donohoe&author=K%20Roethe&author=JL%20Osborn&publication_year=&journal=Am%20J%20Physiol%20Renal%20Physiol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-24">24.</a><div class="reference-content">Spurgeon KR, Donohoe DL, Basile DP. Transforming growth factor-beta in acute renal failure: receptor expression, effects on proliferation, cellularity, and vascularization after recovery from injury. <I xmlns:helper="urn:XsltStringHelper"> Am J Physiol Renal Physiol</I>. 2005;288(3):F568-F57715536165<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15536165" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Transforming%20growth%20factor-beta%20in%20acute%20renal%20failure%3A%20receptor%20expression%2C%20effects%20on%20proliferation%2C%20cellularity%2C%20and%20vascularization%20after%20recovery%20from%20injury.&author=KR%20Spurgeon&author=DL%20Donohoe&author=DP%20Basile&publication_year=&journal=Am%20J%20Physiol%20Renal%20Physiol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1152/ajprenal.00330.2004" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1152/ajprenal.00330.2004" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-25">25.</a><div class="reference-content">Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. <I xmlns:helper="urn:XsltStringHelper"> JAMA</I>. 2004;291(15):1864-187015100205<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15100205" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Lipid-lowering%20therapy%20with%20statins%20in%20high-risk%20elderly%20patients%3A%20the%20treatment-risk%20paradox.&author=DT%20Ko&author=M%20Mamdani&author=DA%20Alter&publication_year=&journal=JAMA&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.291.15.1864" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jama.291.15.1864" xmlns:helper="urn:XsltStringHelper"> </span></div></div></div> </div> </div> </div> <div id="related-tab" class="resource-tab js-resource-tab related-tab need-jobs-ad"> <div class="widget-ArticleLinks widget-instance-AMA_See_Also_Related_Content"> <ul class="article-links related-content"> <li class="article-link related-article odd"> <a href="https://jamanetwork.com/journals/jama/fullarticle/184566" class="td-n"> <div class="related-article-title">Chronic on Acute Renal Failure</div> <div class="related-journal-name">JAMA</div> <div class="related-article-type">Editorial</div> <div class="related-article-date">September 16, 2009</div> <div class="related-article-excerpt"></div> <div class="related-article-authors">Sushrut S. Waikar, MD, MPH; Wolfgang C. Winkelmayer, MD, MPH, ScD</div> </a> </li> </ul> </div> <div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links"> </div> <div class="widget-RelatedTopics widget-instance-AMA_Related_Topics"> <div class="related-topics-block"> <h4 class="related-topics-heading topic-suggestions-heading sb-sc"> See More About </h4> <div class="related-topics topic-suggestions"> <a href="https://jamanetwork.com/collections/5494/acute-kidney-injury" id="item_Link" class="related-topic topic-suggestion no-wrap sb-anchor-light">Acute Kidney Injury</a> <a href="https://jamanetwork.com/collections/5769/nephrology" id="item_Link_1" class="related-topic topic-suggestion no-wrap sb-anchor-light">Nephrology</a> <a href="https://jamanetwork.com/collections/42130/renal-replacement" id="item_Link_2" class="related-topic topic-suggestion no-wrap sb-anchor-light">Renal Replacement</a> </div> </div> </div> <div class="ymal--footer"> <div class="widget-WidgetLoader widget-instance-AMA_PersonalizedContent_SplitScreenView_Footer"> <div class="SCM-SharedWidgets-AsyncWidgetLoader" data-url="/Personalization/PersonalizedContent/AMA_PersonalizedContent_SplitScreenView_Footer" data-params="{"parameters":{"resourceIdToExclude":184587,"resourceTypeToExclude":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <hr /> <div class="manage-interest"> <h4><a href="#" class="manage-interests-link-no-access thm-col-sec">Select Your Interests</a></h4> <div class="widget-ManageCollectionInterests widget-instance-ManageCollectionInterests_SplitScreen"> <div class="manage-interests-modal reveal-modal small modal" data-reveal> <div class="manage-interests--header"> <div class="widget-SelfServeContent widget-instance-AMA_ManageInterests_Header"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="AllSitesManageInterestsHeader" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style> h4 { font-size: 20px !important; } </style> <h4>Select Your Interests</h4> <p>Customize your JAMA Network experience by selecting one or more topics from the list below.</p> </div> </div> </div><div class="manage-interests--categories"> <ul class="category-list"> <li><span class="category-list-item " data-categoryid="46425">Academic Medicine</span></li> <li><span class="category-list-item " data-categoryid="5489">Acid Base, Electrolytes, Fluids</span></li> <li><span class="category-list-item " data-categoryid="5504">Allergy and Clinical Immunology</span></li> <li><span class="category-list-item " data-categoryid="46447">American Indian or Alaska Natives</span></li> <li><span class="category-list-item " data-categoryid="5510">Anesthesiology</span></li> <li><span class="category-list-item " data-categoryid="42143">Anticoagulation</span></li> <li><span class="category-list-item " data-categoryid="6261">Art and Images in Psychiatry</span></li> <li><span class="category-list-item " data-categoryid="42097">Assisted Reproduction</span></li> <li><span class="category-list-item " data-categoryid="42099">Bleeding and Transfusion</span></li> <li><span class="category-list-item " data-categoryid="5548">Cardiology</span></li> <li><span class="category-list-item " data-categoryid="44036">Caring for the Critically Ill Patient</span></li> <li><span class="category-list-item " data-categoryid="6255">Challenges in Clinical Electrocardiography</span></li> <li><span class="category-list-item " data-categoryid="46435">Climate and Health</span></li> <li><span class="category-list-item " data-categoryid="46448">Climate Change</span></li> <li><span class="category-list-item " data-categoryid="44038">Clinical Challenge</span></li> <li><span class="category-list-item " data-categoryid="44039">Clinical Implications of Basic Neuroscience</span></li> <li><span class="category-list-item " data-categoryid="5614">Clinical Pharmacy and Pharmacology</span></li> <li><span class="category-list-item " data-categoryid="46499">Coaching</span></li> <li><span class="category-list-item " data-categoryid="5575">Complementary and Alternative Medicine</span></li> <li><span class="category-list-item " data-categoryid="44040">Consensus Statements</span></li> <li><span class="category-list-item " data-categoryid="46099">Coronavirus (COVID-19)</span></li> <li><span class="category-list-item " data-categoryid="5584">Critical Care Medicine</span></li> <li><span class="category-list-item " data-categoryid="46325">Cultural Competency</span></li> <li><span class="category-list-item " data-categoryid="44019">Dental Medicine</span></li> <li><span class="category-list-item " data-categoryid="5598">Dermatology</span></li> <li><span class="category-list-item " data-categoryid="44011">Diabetes and Endocrinology</span></li> <li><span class="category-list-item " data-categoryid="46320">Diagnostic Test Interpretation</span></li> <li><span class="category-list-item " data-categoryid="46498">Digital Health</span></li> <li><span class="category-list-item " data-categoryid="42054">Drug Development</span></li> <li><span class="category-list-item " data-categoryid="5621">Emergency Medicine</span></li> <li><span class="category-list-item " data-categoryid="5819">End of Life, Hospice, Palliative Care</span></li> <li><span class="category-list-item " data-categoryid="42107">Environmental Health</span></li> <li><span class="category-list-item " data-categoryid="46387">Equity, Diversity, and Inclusion</span></li> <li><span class="category-list-item " data-categoryid="42108">Ethics</span></li> <li><span class="category-list-item " data-categoryid="5644">Facial Plastic Surgery</span></li> <li><span class="category-list-item " data-categoryid="44012">Gastroenterology and Hepatology</span></li> <li><span class="category-list-item " data-categoryid="5664">Genetics and Genomics</span></li> <li><span class="category-list-item " data-categoryid="44041">Genomics and Precision Health</span></li> <li><span class="category-list-item " data-categoryid="5668">Geriatrics</span></li> <li><span class="category-list-item " data-categoryid="5670">Global Health</span></li> <li><span class="category-list-item " data-categoryid="46427">Guide to Statistics and Methods</span></li> <li><span class="category-list-item " data-categoryid="5672">Guidelines</span></li> <li><span class="category-list-item " data-categoryid="5674">Hair Disorders</span></li> <li><span class="category-list-item " data-categoryid="42113">Health Care Delivery Models</span></li> <li><span class="category-list-item " data-categoryid="42114">Health Care Economics, Insurance, Payment</span></li> <li><span class="category-list-item " data-categoryid="42116">Health Care Quality</span></li> <li><span class="category-list-item " data-categoryid="5680">Health Care Reform</span></li> <li><span class="category-list-item " data-categoryid="5830">Health Care Safety</span></li> <li><span class="category-list-item " data-categoryid="5682">Health Care Workforce</span></li> <li><span class="category-list-item " data-categoryid="5679">Health Disparities</span></li> <li><span class="category-list-item " data-categoryid="46328">Health Inequities</span></li> <li><span class="category-list-item " data-categoryid="44020">Health Policy</span></li> <li><span class="category-list-item " data-categoryid="46451">Health Systems Science</span></li> <li><span class="category-list-item " data-categoryid="5688">Hematology</span></li> <li><span class="category-list-item " data-categoryid="5692">History of Medicine</span></li> <li><span class="category-list-item " data-categoryid="5514">Humanities</span></li> <li><span class="category-list-item " data-categoryid="5697">Hypertension</span></li> <li><span class="category-list-item " data-categoryid="44043">Images in Neurology</span></li> <li><span class="category-list-item " data-categoryid="45887">Implementation Science</span></li> <li><span class="category-list-item " data-categoryid="5702">Infectious Diseases</span></li> <li><span class="category-list-item " data-categoryid="44044">Innovations in Health Care Delivery</span></li> <li><span class="category-list-item " data-categoryid="46477">JAMA Forum</span></li> <li><span class="category-list-item " data-categoryid="44070">JAMA Infographic</span></li> <li><span class="category-list-item " data-categoryid="5716">Law and Medicine</span></li> <li><span class="category-list-item " data-categoryid="45308">Leading Change</span></li> <li><span class="category-list-item " data-categoryid="44045">Less is More</span></li> <li><span class="category-list-item " data-categoryid="46327">LGBTQIA Medicine</span></li> <li><span class="category-list-item " data-categoryid="5720">Lifestyle Behaviors</span></li> <li><span class="category-list-item " data-categoryid="45311">Medical Coding</span></li> <li><span class="category-list-item " data-categoryid="5738">Medical Devices and Equipment</span></li> <li><span class="category-list-item " data-categoryid="44023">Medical Education</span></li> <li><span class="category-list-item " data-categoryid="5739">Medical Education and Training</span></li> <li><span class="category-list-item " data-categoryid="5713">Medical Journals and Publishing</span></li> <li><span class="category-list-item " data-categoryid="5746">Melanoma</span></li> <li><span class="category-list-item " data-categoryid="5766">Narrative Medicine</span></li> <li><span class="category-list-item " data-categoryid="5769">Nephrology</span></li> <li><span class="category-list-item " data-categoryid="5777">Neurology</span></li> <li><span class="category-list-item " data-categoryid="44052">Neuroscience and Psychiatry</span></li> <li><span class="category-list-item " data-categoryid="44053">Notable Notes</span></li> <li><span class="category-list-item " data-categoryid="5787">Nursing</span></li> <li><span class="category-list-item " data-categoryid="5788">Nutrition</span></li> <li><span class="category-list-item " data-categoryid="44027">Nutrition, Obesity, Exercise</span></li> <li><span class="category-list-item " data-categoryid="5791">Obesity</span></li> <li><span class="category-list-item " data-categoryid="44013">Obstetrics and Gynecology</span></li> <li><span class="category-list-item " data-categoryid="5796">Occupational Health</span></li> <li><span class="category-list-item " data-categoryid="5801">Oncology</span></li> <li><span class="category-list-item " data-categoryid="5804">Ophthalmology</span></li> <li><span class="category-list-item " data-categoryid="5808">Orthopedics</span></li> <li><span class="category-list-item " data-categoryid="5811">Otolaryngology</span></li> <li><span class="category-list-item " data-categoryid="44028">Pain Medicine</span></li> <li><span class="category-list-item " data-categoryid="46446">Palliative Care</span></li> <li><span class="category-list-item " data-categoryid="44029">Pathology and Laboratory Medicine</span></li> <li><span class="category-list-item " data-categoryid="45306">Patient Care</span></li> <li><span class="category-list-item " data-categoryid="6258">Patient Information</span></li> <li><span class="category-list-item " data-categoryid="5843">Pediatrics</span></li> <li><span class="category-list-item " data-categoryid="44060">Performance Improvement</span></li> <li><span class="category-list-item " data-categoryid="45315">Performance Measures</span></li> <li><span class="category-list-item " data-categoryid="42050">Perioperative Care and Consultation</span></li> <li><span class="category-list-item " data-categoryid="42125">Pharmacoeconomics</span></li> <li><span class="category-list-item " data-categoryid="42126">Pharmacoepidemiology</span></li> <li><span class="category-list-item " data-categoryid="5851">Pharmacogenetics</span></li> <li><span class="category-list-item " data-categoryid="44030">Pharmacy and Clinical Pharmacology</span></li> <li><span class="category-list-item " data-categoryid="5856">Physical Medicine and Rehabilitation</span></li> <li><span class="category-list-item " data-categoryid="42059">Physical Therapy</span></li> <li><span class="category-list-item " data-categoryid="45313">Physician Leadership</span></li> <li><span class="category-list-item " data-categoryid="44061">Poetry</span></li> <li><span class="category-list-item " data-categoryid="45316">Population Health</span></li> <li><span class="category-list-item " data-categoryid="46445">Primary Care</span></li> <li><span class="category-list-item " data-categoryid="45309">Professional Well-being</span></li> <li><span class="category-list-item " data-categoryid="44064">Professionalism</span></li> <li><span class="category-list-item " data-categoryid="5871">Psychiatry and Behavioral Health</span></li> <li><span class="category-list-item " data-categoryid="42128">Public Health</span></li> <li><span class="category-list-item " data-categoryid="5877">Pulmonary Medicine</span></li> <li><span class="category-list-item " data-categoryid="42129">Radiology</span></li> <li><span class="category-list-item " data-categoryid="42058">Regulatory Agencies</span></li> <li><span class="category-list-item " data-categoryid="46443">Reproductive Health</span></li> <li><span class="category-list-item " data-categoryid="5916">Research, Methods, Statistics</span></li> <li><span class="category-list-item " data-categoryid="42142">Resuscitation</span></li> <li><span class="category-list-item " data-categoryid="5896">Rheumatology</span></li> <li><span class="category-list-item " data-categoryid="46326">Risk Management</span></li> <li><span class="category-list-item " data-categoryid="38802">Scientific Discovery and the Future of Medicine</span></li> <li><span class="category-list-item " data-categoryid="46495">Sexual Health</span></li> <li><span class="category-list-item " data-categoryid="5833">Shared Decision Making and Communication</span></li> <li><span class="category-list-item " data-categoryid="5912">Sleep Medicine</span></li> <li><span class="category-list-item " data-categoryid="5915">Sports Medicine</span></li> <li><span class="category-list-item " data-categoryid="5533">Stem Cell Transplantation</span></li> <li><span class="category-list-item " data-categoryid="5921">Substance Use and Addiction Medicine</span></li> <li><span class="category-list-item " data-categoryid="5923">Surgery</span></li> <li><span class="category-list-item " data-categoryid="44065">Surgical Innovation</span></li> <li><span class="category-list-item " data-categoryid="44066">Surgical Pearls</span></li> <li><span class="category-list-item " data-categoryid="44067">Teachable Moment</span></li> <li><span class="category-list-item " data-categoryid="44034">The Art of JAMA</span></li> <li><span class="category-list-item " data-categoryid="44037">The Arts and Medicine</span></li> <li><span class="category-list-item " data-categoryid="6257">The Rational Clinical Examination</span></li> <li><span class="category-list-item " data-categoryid="5936">Tobacco and e-Cigarettes</span></li> <li><span class="category-list-item " data-categoryid="5938">Toxicology</span></li> <li><span class="category-list-item " data-categoryid="46433">Translational Medicine</span></li> <li><span class="category-list-item " data-categoryid="42136">Trauma and Injury</span></li> <li><span class="category-list-item " data-categoryid="5942">Treatment Adherence</span></li> <li><span class="category-list-item " data-categoryid="46323">Ultrasonography</span></li> <li><span class="category-list-item " data-categoryid="5947">Urology</span></li> <li><span class="category-list-item " data-categoryid="44069">Users' Guide to the Medical Literature</span></li> <li><span class="category-list-item " data-categoryid="5950">Vaccination</span></li> <li><span class="category-list-item " data-categoryid="5955">Venous Thromboembolism</span></li> <li><span class="category-list-item " data-categoryid="45312">Veterans Health</span></li> <li><span class="category-list-item " data-categoryid="5957">Violence</span></li> <li><span class="category-list-item " data-categoryid="42139">Women's Health</span></li> <li><span class="category-list-item " data-categoryid="45307">Workflow and Process</span></li> <li><span class="category-list-item " data-categoryid="42140">Wound Care, Infection, Healing</span></li> </ul> </div> <div class="manage-interests--save-preferences"> <div class="save-preferences-btn thm-bg "> <span class="save-preferences-btn-text fw-b">Save Preferences</span> </div> </div> <div class="manage-interests--privacy-terms"> <a class="manage-interests--privacy-terms-color" href="/pages/privacy-policy">Privacy Policy</a> | <a class="manage-interests--privacy-terms-color" href="/pages/terms-of-use">Terms of Use</a></div> <a class="close-reveal-modal icon-close"></a> </div> </div> </div> <h4 class="thm-col-sec" align="center"> Others Also Liked </h4> <div id="trendmd-suggestions"></div> </div> <div id="comments-tab" class="resource-tab js-resource-tab comments-tab js-comments-tab single-comment-view"> </div> </div> </div> <a id="skip-to-navigation" href="#" tabindex="-1"></a> <div id="content-panel" class="content-panel"> <a id="top"></a> <div id="full-text-tab" class="resource-tab js-resource-tab full-text-tab"> <div class="widget-ArticleLinks widget-instance-AMA_ErrataArticleLinks_FullText"> </div> <div class="widget-ArticleLinks widget-instance-AMA_ArticleLinks_ToErrata_FullText"> </div> <div class="widget-ArticleNavLinks widget-instance-AMA_ArticleNavLinks"> <a class="toc-link btn" href="https://jamanetwork.com/journals/jama/issue/302/11">This Issue</a> </div> <div class="article-metrics-wrapper" id="divArticleLevelMetrics"> <div class="widget-ArticleLevelMetrics widget-instance-AMA_ArticleMetrics"> <div class="artmet-condensed-wrap clearfix"> <div class="artmet-condensed-stats clearfix"> <div class="artmet-item artmet-citations"> <a class="artmet-citations-link" href="https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=silverchair&SrcAuth=WosAPI&KeyUT=WOS:000269797600027&DestLinkType=FullRecord&DestApp=WOS_CPL" target="_blank"> <span class="artmet-text">Citations</span> <span class="artmet-number">570</span> </a> </div> </div> <div class="artmet-modal-trigger-wrap"> <a rel="nofollow" class="artmet-modal-trigger" data-article-id="184587"><i class="icon-metrics"></i><span>View Metrics</span></a> </div> </div> </div> </div> <ul class="toolbar"> <li class="toolbar-pdf-wrap toolbar-tool-wrap"> <a id="pdf-link" href="/journals/jama/articlepdf/184587/joc90093_1179_1185.pdf" class="toolbar-tool toolbar-pdf al-link pdfaccess js-pdfaccess" data-article-id="184587" data-article-url="/journals/jama/articlepdf/184587/joc90093_1179_1185.pdf" data-ajax-url="/Content/CheckPdfAccess"><span class="toolbar-pdf-text"><span class="toolbar-link-text-extra">Download </span><span class="toolbar-link-text">PDF</span></span> </a> </li> <li class="toolbar-share-wrap toolbar-tool-wrap"> <div class="toolbar-tool"> <a class="st-custom-button addthis_button_twitter is-b toolbar-twitter toolbar-share" data-network="twitter" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">X</span> </a> <a class="st-custom-button addthis_button_facebook is-b toolbar-facebook toolbar-share" data-network="facebook" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">Facebook</span> </a> <a class="toolbar-share-more-link is-a" rel="nofollow"><span class="icon icon-carrot_down social-arrow"></span><span class="more-text-wrap">More</span></a> <div class="toolbar-share-more"> <a class="st-custom-button addthis_button_linkedin is-b toolbar-linkedin toolbar-share" data-network="linkedin" data-title="" data-url="" data-email-subject="" rel="nofollow" href="javascript:;"> <span class="share-text">LinkedIn</span> </a> </div> </div> </li> <li class="toolbar-citation-wrap toolbar-tool-wrap"> <div class="widget-ToolboxGetCitation widget-instance-AMA_Get_Citation"> <a class="toolbar-tool toolbar-citation is-b stats-citation" rel="nofollow" data-reveal-id="get-citation" data-reveal> <span class="toolbar-link-text">Cite</span> <span class="toolbar-link-text-extra">This</span> </a> <div id="get-citation" class="reveal-modal get-citation" data-reveal> <h3 class="get-citation-title">Citation</h3> <p class="get-citation-citation">Wald R<span class='al-author-delim'>, </span>Quinn RR<span class='al-author-delim'>, </span>Luo J, et al. Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis. <em>JAMA.</em> 2009;302(11):1179–1185. doi:10.1001/jama.2009.1322</p> <h4 class="get-citation-download-heading">Manage citations:</h4> <div class="get-citation-types"> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=0">Ris (Zotero)</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=1">EndNote</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=2">BibTex</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=3">Medlars</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=0">ProCite</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=3">RefWorks</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=0">Reference Manager</a> <a class="get-citation-format" rel="nofollow" href="/Citation/Download?resourceId=184587&resourceType=3&citationFormat=0">Mendeley</a> </div> <p class="get-citation-copyright">© 2024 </p> <a class="close-reveal-modal icon-close" rel="nofollow"></a> </div> </div> </li> <li class="toolbar-permissions-wrap toolbar-tool-wrap"> <div class="widget-ToolboxPermissions widget-instance-AMA_Get_Permissions"> <a href="http://s100.copyright.com/AppDispatchServlet?publisherName=AMA&publication=0098-7484&title=Chronic+Dialysis+and+Death+Among+Survivors+of+Acute+Kidney+Injury+Requiring+Dialysis&publicationDate=2009-09-16&volumeNum=302&issueNum=11&author=Wald%2c+Ron%3b+Quinn%2c+Robert+R.&startPage=1179&endPage=1185&contentId=10.1001%2fjama.2009.1322&oa=&orderBeanReset=True" rel="nofollow" id="PermissionsLink" class="toolbar-tool toolbar-permissions is-b" target="_blank"><span class="toolbar-link-text">Permissions</span></a> </div> </li> </ul> <div class="widget-ArticleTopInfo widget-instance-AMA_ArticleTop_Info_Widget"> <div class="meta-access-type free-access is-b"></div> <span class="hide tagmanagervalue" data-attribute="articleId" data-value="184587" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="arrArticleAuthor" data-value="Ron%20Wald%2C%20MDCM%2C%20MPH%2C%20FRCPC,Robert%20R.%20Quinn%2C%20MD%2C%20FRCPC,Jin%20Luo%2C%20MD,Ping%20Li%2C%20PhD,Damon%20C.%20Scales%2C%20MD%2C%20PhD%2C%20FRCPC,Muhammad%20M.%20Mamdani%2C%20PharmD%2C%20MPH,Joel%20G.%20Ray%2C%20MD%2C%20MSc%2C%20FRCPC,for%20the%20University%20of%20Toronto%20Acute%20Kidney%20Injury%20Research%20Group" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="articleDOI" data-value="10.1001/jama.2009.1322" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articleTitle" data-value="Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="type" data-value="Original Contribution" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueVolume" data-value="302" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueNo" data-value="11" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="publishDate" data-value="September 16, 2009" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="topics" data-value="Acute Kidney Injury, Nephrology, Renal Replacement" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="topicCode" data-value="5494, 5769, 42130" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="category" data-value="Research" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="journalClub" data-value="No" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentStatus" data-value="Free" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articlePubState" data-value="Final" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentMedium" data-value="Article" data-type="string"></span> <div class="meta-article-type-wrap"> <div class="meta-article-type thm-col">Original Contribution </div> </div> <div class="meta-date">September 16, 2009</div> <div class="meta-article-title-wrap"> <h1 class="meta-article-title ">Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis</h1> </div> <div class="meta-authors"> <span class="meta-authors--limited"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Ron+Wald&q=Ron+Wald" rel=nofollow target="_blank">Ron Wald, MDCM, MPH, FRCPC<sup></sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Robert+R.+Quinn&q=Robert+R.+Quinn" rel=nofollow target="_blank">Robert R. Quinn, MD, FRCPC<sup></sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jin+Luo&q=Jin+Luo" rel=nofollow target="_blank">Jin Luo, MD<sup></sup></a></span>; <a class="meta-authors--etal td-u stats-meta-authors--etal">et al</a></span> <span class="meta-authors--remaining"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Ping+Li&q=Ping+Li" rel=nofollow target="_blank">Ping Li, PhD<sup></sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Damon+C.+Scales&q=Damon+C.+Scales" rel=nofollow target="_blank">Damon C. Scales, MD, PhD, FRCPC<sup></sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Muhammad+M.+Mamdani&q=Muhammad+M.+Mamdani" rel=nofollow target="_blank">Muhammad M. Mamdani, PharmD, MPH<sup></sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Joel+G.+Ray&q=Joel+G.+Ray" rel=nofollow target="_blank">Joel G. Ray, MD, MSc, FRCPC<sup></sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=for+the+University+of+Toronto+Acute+Kidney+Injury+Research+Group&q=for+the+University+of+Toronto+Acute+Kidney+Injury+Research+Group" rel=nofollow target="_blank">for the University of Toronto Acute Kidney Injury Research Group<sup></sup></a></span></span> </div> <div class="meta-author"> <a class="meta-author-title is-b stats-meta-author-toggle" data-tog-target=".meta-author-content">Author Affiliations</a> <a class="meta-articleinfo-jumplink section-jump-link scroll-to stats-scroll-to-articleinfo" data-tab-toggle=".tab-nav-full-text" href="#24832888">Article Information</a> <div class="meta-author-content"> <div class="meta-author-notes"><p class="para"><div class="authorInfo" xmlns:ml="http://www.w3.org/1998/Math/MathML"><p class="para"><strong>Author Affiliations:</strong> Divisions of Nephrology (Dr Wald) and General Internal Medicine (Dr Ray), St Michael's Hospital; The Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital (Drs Wald, Mamdani, and Ray); Department of Medicine, University of Toronto (Drs Wald, Scales, Mamdani, and Ray); Division of Nephrology (Dr Quinn) and Department of Critical Care Medicine (Dr Scales), Sunnybrook Health Sciences Centre; and the Institute for Clinical Evaluative Sciences (Drs Luo, Li, Scales, Mamdani, and Ray), all in Toronto, Ontario, Canada, and Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia (Dr Mamdani).</p></div></p></div> </div> </div> <div class="meta-citation-wrap"> <span class="meta-citation-journal-name">JAMA. </span><span class="meta-citation"> 2009;302(11):1179-1185. doi:10.1001/jama.2009.1322</span> </div> </div> <div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links"> </div> <div class="widget-LinkedContentToolbar widget-instance-AMA_LinkedContentToolbar"> <div class="linked-content-toolbar"> <div class="hidden js-search-open-multimedia-by-default" showContentByDefault="False"></div> <div class="linked-content-controls"> <a class="linked-content-trigger td-n stats-graphical-abstract" href="#graphical-abstract-tab"> <i class="icon-visual-abstract"><span class="sr-t">visual abstract icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Visual <div>Abstract</div></div> </a> <a class="linked-content-trigger td-n stats-editorial-comment" href="#editorial-comment-tab"> <i class="icon-document"><span class="sr-t">editorial comment icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Editorial <div>Comment</div></div> </a> <a class="linked-content-trigger td-n stats-related-articles" href="#related-articles-tab"> <i class="icon-related"><span class="sr-t">related articles icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Related <div>Articles</div></div> </a> <a class="linked-content-trigger td-n stats-author-interviews" href="#author-interviews-tab"> <i class="icon-author_interview"><span class="sr-t">author interview icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Interviews</div> </a> <a class="linked-content-trigger td-n stats-more-multimedia" href="#more-multimedia-tab"> <i class="icon-multimedia"><span class="sr-t">multimedia icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Multimedia</div> </a> <a class="linked-content-trigger td-n stats-listen-to-this-article" href="#listen-to-this-article-tab"> <i class="icon-audio"><span class="sr-t">audio icon</span></i> <div class="trigger-text d-ib va-m ta-l fw-5">Listen to <div>this article</div></div> </a> </div> <div class="linked-content-tabs"> <div id="graphical-abstract-tab" class="linked-content-tab graphical-abstract-tab"> <div class="widget-SectionDisplay widget-instance-AMA_GraphicalAbstract_Tab"> </div> </div> <div id="editorial-comment-tab" class="linked-content-tab editorial-comment-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_EditorialComments"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/184566"> <div class="related-article-type">Editorial</div> <div class="related-article-title sb-tc">Chronic on Acute Renal Failure</div> </a> <div class="related-article-authors">Sushrut S. Waikar, MD, MPH; Wolfgang C. Winkelmayer, MD, MPH, ScD</div> <div class="related-article-journal-name">JAMA</div> </li> </ul> </div> </div> <div id="related-articles-tab" class="linked-content-tab related-article-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedArticle"> </div> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedEditorsChoices"> </div> </div> <div id="author-interviews-tab" class="linked-content-tab linked-author-interviews-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_AuthorInterviews"> </div> </div> <div id="listen-to-this-article-tab" class="linked-content-tab linked-listen-to-this-article-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_ListenToThisArticle"> </div> </div> <div id="more-multimedia-tab" class="linked-content-tab more-multimedia-tab"> </div> </div> </div> </div> <div class="widget-ArticleFulltext widget-instance-AMA_Article_FullText_Widget"> <div class="article-full-text" data-userHasAccess="True"> <a class="article-section-id-anchor" id="24832838"></a> <div class="h3 cb section-type-abstract decorated-hed "> <div class="heading-text thm-col sb-sc"> Abstract </div> </div> <p><strong>Context</strong> Severe acute kidney injury among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who survive to hospital discharge.</p><p><strong>Objective</strong> To assess the risk of chronic dialysis and all-cause mortality in individuals who experience an episode of acute kidney injury requiring dialysis.</p><p><strong>Design, Setting, and Participants</strong> We conducted a population-based cohort study of all adult patients in Ontario, Canada, with acute kidney injury who required in-hospital dialysis and survived free of dialysis for at least 30 days after discharge between July 1, 1996, and December 31, 2006. These individuals were matched with patients without acute kidney injury or dialysis during their index hospitalization. Matching was by age plus or minus 5 years, sex, history of chronic kidney disease, receipt of mechanical ventilation during the index hospitalization, and a propensity score for developing acute kidney injury requiring dialysis. Patients were followed up until March 31, 2007.</p><p><strong>Main Outcome Measures</strong> The primary end point was the need for chronic dialysis and the secondary outcome was all-cause mortality.</p><p><strong>Results</strong> We identified 3769 adults with acute kidney injury requiring in-hospital dialysis and 13 598 matched controls. The mean age was 62 years and median follow-up was 3 years. The incidence rate of chronic dialysis was 2.63 per 100 person-years among individuals with acute kidney injury requiring dialysis, and 0.91 per 100 person-years among control participants (adjusted hazard ratio, 3.23; 95% confidence interval, 2.70-3.86). All-cause mortality rates were 10.10 and 10.85 per 100 person-years, respectively (adjusted hazard ratio, 0.95; 95% confidence interval, 0.89-1.02).</p><p><strong>Conclusions</strong> Acute kidney injury necessitating in-hospital dialysis was associated with an increased risk of chronic dialysis but not all-cause mortality.</p> <div class="movable-ad-target bta"> </div> <a class="article-section-id-anchor" id="24832839"></a> <p class="para">Acute kidney injury, which leads to a sudden decline in kidney function, is a common and serious complication of hospitalization in the adult population.<sup><a href="#ref-joc90093-1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">1</a></sup><sup>-<a href="#ref-joc90093-1" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">4</a></sup> Many patients with severe acute kidney injury require initiation of hemodialysis or hemofiltration (termed <em>dialysis</em> throughout), and their in-hospital mortality rate ranges from 45% to 70%.<sup><a href="#ref-joc90093-5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup><sup>-<a href="#ref-joc90093-5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">12</a></sup> Among those who survive, as many as 15% require dialysis at the time of discharge.<sup><a href="#ref-joc90093-6" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">6</a></sup><sup>,<a href="#ref-joc90093-9" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">9</a></sup></p> <a class="article-section-id-anchor" id="24832840"></a> <p class="para">Little is known about the long-term outcomes of patients with acute kidney injury requiring in-hospital dialysis, especially once they leave the hospital and recover enough kidney function to be free of dialysis in the short term. Prior studies were conducted in single centers or within restricted geographic regions,<sup><a href="#ref-joc90093-5" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">5</a></sup><sup>,<a href="#ref-joc90093-8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup><sup>,<a href="#ref-joc90093-10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup><sup>,<a href="#ref-joc90093-13" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a></sup><sup>,<a href="#ref-joc90093-14" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">14</a></sup> and few studies observed patients for more than 1 year.<sup><a href="#ref-joc90093-8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup><sup>,<a href="#ref-joc90093-14" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">14</a></sup><sup>,<a href="#ref-joc90093-15" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">15</a></sup> Accordingly, little is known about a common clinical scenario in which prognostic implications include resource allocation, specialist follow-up, and dialysis planning.</p> <a class="article-section-id-anchor" id="24832841"></a> <p class="para">The universal health care system in the Canadian province of Ontario provides a unique opportunity to study long-term outcomes and health care use across multiple study centers and among an entire population. We evaluated the long-term risk of chronic dialysis and death among hospitalized patients who sustained acute kidney injury requiring acute dialysis.</p> <a class="article-section-id-anchor" id="24832842"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Methods </div> </div> <a class="article-section-id-anchor" id="24832843"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Design and Participants </div> </div> <a class="article-section-id-anchor" id="24832844"></a> <p class="para">We completed a retrospective matched cohort study using linked administrative health databases for all of Ontario. We identified all adults aged 19 years and older admitted to an acute care hospital between July 1, 1996, and December 31, 2006, for whom length of stay was less than 180 days. To identify a cohort of survivors, we focused on those individuals who lived for at least 30 days after the index hospitalization discharge date without receipt of dialysis or rehospitalization. We excluded individuals with a diagnosis of acute kidney injury, receipt of a kidney transplant, or any form of dialysis in the 5-year period preceding the index hospitalization.</p> <a class="article-section-id-anchor" id="24832845"></a> <p class="para">As the exposed group, we selected from the previously described cohort all individuals who had both acute kidney injury and acute dialysis during the index admission. Each exposed patient was then matched with 4 unexposed hospitalized patients (without acute kidney injury or acute dialysis) according to the following matching variables: age within 5 years, sex, history of chronic kidney disease in the 5-year period prior to the index hospitalization admission date, receipt of mechanical ventilation during the index hospitalization, and logit of a propensity score for developing acute kidney injury and dialysis ±0.2 standard deviations.</p> <a class="article-section-id-anchor" id="24832846"></a> <p class="para">The receipt of mechanical ventilation was used as a surrogate for admission to a critical care unit.<sup><a href="#ref-joc90093-16" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">16</a></sup> The propensity score was used to characterize known risk factors for acute kidney injury and dialysis.<sup><a href="#ref-joc90093-17" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">17</a></sup> The propensity score was derived using a multivariable logistic regression model that included the following variables: age (continuous in years), sex, and income quintile at the hospital discharge date; chronic kidney disease in the 5 years preceding the hospital admission date; number of hospitalizations or health care visits to any physician or emergency department in the 5 years preceding the hospital discharge date; receipt of coronary, carotid, or peripheral arterial revascularization, cardiac valve surgery, coronary angiography, cardiac stress testing, echocardiography, single 12-lead or ambulatory 24-hour electrocardiography, pacemaker insertion or carotid Doppler ultrasonography in the 5 years before the hospital discharge date; diagnosed liver dysfunction, heart failure, diabetes mellitus, cancer, cerebrovascular disease, cardiac dysrhythmias, myocardial infarction or angina, peripheral artery disease, major infection, alcoholism, and score on the Charlson Comorbidity Index<sup><a href="#ref-joc90093-18" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">18</a></sup> in the 5 years before the hospital discharge date; quarter and year of the index hospitalization; and sepsis, receipt of mechanical ventilization, nonruptured aortic aneurysm repair, or cardiac surgery, all within the index hospitalization. Although 4 nonexposed matches were sought for each exposed patient, those with at least 1 match were included.</p> <a class="article-section-id-anchor" id="24832848"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Data Sources </div> </div> <a class="article-section-id-anchor" id="24832850"></a> <p class="para">The study was completed using linked provincial health care administrative databases at the Institute for Clinical Evaluative Sciences. These databases have been used in numerous large-scale epidemiologic studies.<sup><a href="#ref-joc90093-19" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">19</a></sup><sup>,<a href="#ref-joc90093-20" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">20</a></sup> Hospitalization records were obtained from the Canadian Institute for Heath Information Discharge Abstract Database (DAD), which was used to identify an acute hospitalization, the presence of acute kidney injury, and receipt of acute dialysis, as well as in-patient comorbidities and procedures (<a class="supplementary-material">eTable</a>). The DAD contains the encrypted health care number, age and sex of the individual, date of admission and discharge, and as many as 16 diagnoses in the <em>International Classification of Diseases, Ninth Revision</em> (before the year 2002) and 25 diagnoses in the <em>International Classification of Diseases, Tenth Revision</em> (from 2002 onward) (<a class="supplementary-material">eTable</a>). The Ontario Health Insurance Plan database contains records of all physician billing for outpatient and inpatient services, including a service date and a single diagnosis. The Registered Persons Database contains health care identifiers for all eligible individuals, as well as a date of death.</p> <a class="article-section-id-anchor" id="24832852"></a> <p class="para">Income quintile was based on the 2001 Statistics Canada Census, which assigns income quintiles to each neighborhood community, with 1 representing the lowest income quintile and 5 representing the highest.</p> <a class="article-section-id-anchor" id="24832854"></a> <p class="para">The health care databases were linked anonymously using encrypted individual health card numbers to safeguard patient confidentiality. The current study was approved by the research ethics board at Sunnybrook Health Sciences Centre.</p> <a class="article-section-id-anchor" id="24832855"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Determining Exposure Status </div> </div> <a class="article-section-id-anchor" id="24832856"></a> <p class="para">The acute kidney injury and dialysis cohort was assembled by identifying hospitalized patients with both a diagnostic code in the DAD of acute kidney injury and either a procedure code in the DAD for dialysis or a physician claim for dialysis made through the Ontario Health Insurance Plan database during the index hospitalization (<a class="supplementary-material">eTable</a>). To focus our interest on acute kidney injury survivors, participants were included who survived for at least 30 days postdischarge with no evidence of dialysis treatment or the need for rehospitalization during this time.</p> <a class="article-section-id-anchor" id="24832857"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Study Outcome </div> </div> <a class="article-section-id-anchor" id="24832858"></a> <p class="para">Patients were tracked for outcomes beginning 30 days after discharge. The main study outcome was receipt of chronic dialysis for at least 90 days. The date of the first dialysis claim was considered to be the date of initiation of chronic dialysis. The secondary outcome was all-cause mortality occurring more than 30 days after hospital discharge.</p> <a class="article-section-id-anchor" id="24832859"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Statistical Analyses </div> </div> <a class="article-section-id-anchor" id="24832860"></a> <p class="para">Continuous variables for individuals with and without acute kidney injury and dialysis were expressed as a mean (SD) or median (interquartile range [IQR]), and compared using an unpaired <em>t</em> test or Kruskal-Wallis test, respectively. Categorical variables were expressed as a percentage and compared using a χ<sup>2</sup> test.</p> <a class="article-section-id-anchor" id="24832861"></a> <p class="para">Time-to-event analyses were performed until March 31, 2007. For the chronic dialysis end point, an individual was censored at death or at the end of the study period. Incidence rates of both chronic dialysis and all-cause mortality were determined for participants with and without acute kidney injury and dialysis. Crude hazard ratios (HRs) and 95% confidence intervals (CIs) were derived from Cox proportional hazards models, and matched individuals without acute kidney injury and dialysis were the reference group. We further adjusted for age (continuous in years) and the propensity score for acute kidney injury and dialysis in the multivariable models, in case there was residual confounding beyond the matching process. Survival curves for chronic dialysis and all-cause mortality were generated from unadjusted Cox models. Adjusted HRs for receipt of chronic dialysis were further stratified according to participant characteristics.</p> <a class="article-section-id-anchor" id="24832862"></a> <p class="para">Based on the actual number of participants enrolled in the current study, we had greater than 95% statistical power to detect an HR of 2.00 or more for the primary study outcome at a conventional <em>P</em> value of .05. All <em>P</em> values were 2-sided, and the significance level was set at .05. Analyses were performed using SAS 9.1 for UNIX (SAS Institute Inc, Cary, North Carolina).</p> <a class="article-section-id-anchor" id="24832863"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Results </div> </div> <a class="article-section-id-anchor" id="24832864"></a> <p class="para">We identified 4066 individuals with acute kidney injury requiring dialysis who survived at least 30 days after hospital discharge without receiving dialysis or further hospitalization (<a href="#joc90093f1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 1</a>). At least 1 match was identified for 3769 (92.7%) of the exposed patients (<a href="#joc90093t1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 1</a>). Hence, 3769 individuals with acute kidney injury and dialysis and 13 598 matches with neither acute kidney injury nor dialysis were included in this study.</p> <a class="article-section-id-anchor" id="24832867"></a> <p class="para">The mean age of the enrolled participants was 62 years, approximately 40% were women, and the mean Charlson Comorbidity Index score was 2.7 (<a href="#joc90093t1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 1</a>). Slightly more than 25% of participants in each group had documented chronic kidney disease in the 5-year period before the index hospital admission. During their hospitalization, 47% of patients with acute kidney injury and dialysis received mechanical ventilation, compared with 42% of those without acute kidney injury and dialysis. The respective rates for cardiac surgery were 11.5% and 10.0%. Approximately 15% of participants in each group had sepsis. The rates of cardiac and noncardiac arteriography were also comparable between groups (<a href="#joc90093t1" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 1</a>).</p> <a class="article-section-id-anchor" id="24832868"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Need for Chronic Dialysis </div> </div> <a class="article-section-id-anchor" id="24832869"></a> <p class="para">After a median (IQR) follow-up of 3 (1-5) years, the incidence rates of chronic dialysis were 2.63 and 0.91 per 100 person-years among those with and without acute kidney injury and dialysis in the index hospitalization, respectively, corresponding to a crude HR of 3.26 (95% CI, 2.73-3.89) (<a href="#joc90093t2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 2</a>; <a href="#joc90093f2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 2</a>A). After adjusting for age and the propensity score, the HR changed little (3.23; 95% CI, 2.70-3.86; <a href="#joc90093t2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 2</a>).</p> <a class="article-section-id-anchor" id="24832872"></a> <p class="para">The increased risk of chronic dialysis following a hospitalization complicated by acute kidney injury and dialysis was consistent across patient subgroups (<a href="#joc90093f3" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 3</a>). This was especially so among patients without a preexisting diagnosis of chronic kidney disease (adjusted HR, 15.54; 95% CI, 9.65-25.03).</p> <a class="article-section-id-anchor" id="24832874"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> All-Cause Mortality </div> </div> <a class="article-section-id-anchor" id="24832875"></a> <p class="para">The incidence rate for all-cause mortality was 10.10 per 100 person-years among patients with acute kidney injury and dialysis, which was slightly lower than among those without in-hospital acute kidney injury (<a href="#joc90093f2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 2</a>B). After adjusting for age and the propensity score, the future risk of death was not significantly different between groups (HR, 0.95; 95% CI, 0.89-1.02; <a href="#joc90093t2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 2</a>).</p> <a class="article-section-id-anchor" id="24832876"></a> <div class="h4 cb section-type-section "> <div class="heading-text "> Unmatched Participants </div> </div> <a class="article-section-id-anchor" id="24832877"></a> <p class="para">There were 297 (7.3%) participants with acute kidney injury and dialysis who could not be matched to a suitable control. Their respective incidence rates of chronic dialysis and all-cause mortality were 4.89 per 100 person-years and 14.18 per 100 person-years, which were higher than rates for the 3769 patients who were successfully matched (<a href="#joc90093t2" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Table 2</a>).</p> <a class="article-section-id-anchor" id="24832878"></a> <div class="h3 cb section-type-section "> <div class="heading-text thm-col sb-sc"> Comment </div> </div> <a class="article-section-id-anchor" id="24832879"></a> <p class="para">We analyzed all patients admitted to Ontario hospitals over a 10-year period and found that survivors of a hospitalization complicated by acute kidney injury requiring dialysis were approximately 3 times more likely to require chronic dialysis compared with those without acute kidney injury. However, no difference was observed between these groups for long-term mortality.</p> <a class="article-section-id-anchor" id="24832880"></a> <p class="para">This study was designed to evaluate long-term renal health among survivors of acute kidney injury receiving dialysis in a large population with universal access to health care. Patients with acute kidney injury have a high acuity level during their hospitalization and a wide array of preexisting illness.<sup><a href="#ref-joc90093-11" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">11</a></sup> Accordingly, we identified matched controls based on a series of key characteristics including the propensity to experience an episode of acute kidney injury requiring dialysis. Because we sought to evaluate long-term outcomes among survivors of severe acute kidney injury, and to reduce the possibility of survivor-treatment bias, we required a 30-day period following hospital discharge in which a participant survived and was free of dialysis.</p> <a class="article-section-id-anchor" id="24832881"></a> <p class="para">We completed our study using administrative data, so there may have been a misclassification of the study exposure (acute kidney injury and dialysis) or other adjustment variables. In a recent validation study, the combination of a diagnostic code for acute kidney injury and a procedure code for dialysis had both sensitivity and specificity of more than 90% for capturing the combination of acute kidney injury and dialysis.<sup><a href="#ref-joc90093-21" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">21</a></sup> However, given the low sensitivity of an acute kidney injury diagnosis code in isolation (28%-35%), it is possible that some participants classified as not having acute kidney injury actually did, leading to an underestimation of outcome differences between groups. In addition, we could not match approximately 7% of study patients with acute kidney injury and dialysis to unaffected controls. Since unmatched individuals had higher rates of chronic dialysis and mortality than those with at least 1 match, their exclusion attenuated the reported effect sizes. Finally, we cannot exclude the possibility of residual confounding despite our rigorous matching and adjustment on important variables.</p> <a class="article-section-id-anchor" id="24832882"></a> <p class="para">We could not obtain measures of kidney function, such as serum creatinine or urinary protein excretion, neither at discharge nor during postdischarge follow-up, and were limited to measuring the outcome of chronic dialysis, for which reliable claims-based data exist. Indeed, many patients who survived acute kidney injury and dialysis may have had persistent or worsening renal dysfunction after hospital discharge, but not so severe as to warrant dialysis. We also used a widely accepted definition for chronic dialysis—the receipt of dialysis for at least 90 days. A shortcoming of this approach is that it misclassifies individuals who truly developed end-stage renal disease, but who died in the first 90 days after commencing chronic dialysis. However, since the risk of death was not significantly higher in individuals with acute kidney injury and dialysis than matched patients with no acute kidney injury, it is unlikely that this potential misclassification had an effect on the risk of chronic dialysis.</p> <a class="article-section-id-anchor" id="24832883"></a> <p class="para">Small studies have previously evaluated the outcomes of survivors of acute kidney injury requiring dialysis. Schiffl studied 425 patients with acute tubular necrosis who required acute dialysis at a single institution.<sup><a href="#ref-joc90093-10" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">10</a></sup><sup>,<a href="#ref-joc90093-14" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">14</a></sup> Among the 225 participants alive at discharge, survival was 66% and 53% at 1 and 5 years, respectively. Morgera et al used follow-up data for 89% of the 301 patients discharged from their institution following acute kidney injury and receipt of continuous dialysis.<sup><a href="#ref-joc90093-8" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">8</a></sup> Survival at 6 and 12 months was 77% and 69%, respectively. Information about renal function, available for about one-third of survivors, revealed that 10% required chronic dialysis and 40% had some degree of persistent renal insufficiency. Bagshaw et al observed a 1-year survival rate of 90% and a chronic dialysis rate of 22% among 97 Albertans discharged alive following dialysis for acute kidney injury.<sup><a href="#ref-joc90093-13" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">13</a></sup> While these studies clearly shed some light on the health outcomes of acute kidney injury survivors, most data were derived from single centers or local health regions and were based on small cohorts. The absence of a comparator group in these studies also prevents one from determining the degree to which acute kidney injury and dialysis is a prognosticator for long-term health status in excess of global patient comorbidity before and during the index hospitalization. Finally, since survivorship was assessed starting from the hospital discharge date, patients who died shortly following discharge, and who may not have been candidates for future dialysis, may have been inappropriately included.</p> <a class="article-section-id-anchor" id="24832884"></a> <p class="para">Ishani et al previously used American Medicare administrative data to identify approximately 7000 patients older than 67 years with hospital-associated acute kidney injury who survived to discharge.<sup><a href="#ref-joc90093-22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> Postdischarge mortality was doubled and the risk of chronic dialysis was increased by nearly 7 times among survivors of acute kidney injury. These risks were accentuated in patients with preexisting chronic kidney disease. However, their cohort study<sup><a href="#ref-joc90093-22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> was limited to individuals older than 67 years, and they did not distinguish between patients with acute kidney injury who required dialysis and those who did not. This study used a fairly limited set of covariates, and thus, increased the likelihood of confounding within their risk estimates. Among individuals in our study with preexisting chronic kidney disease, an episode of acute kidney injury and dialysis was associated with an approximate 2-fold higher risk of a chronic dialysis, which rose to about 15 times higher among patients without previous chronic kidney disease (<a href="#joc90093f3" class="figure-link section-jump-link" data-tab-toggle=".tab-nav-figure-table">Figure 3</a>). Comparing our findings with those of Ishani et al<sup><a href="#ref-joc90093-22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> is challenging, since the Ishani study included controls with neither acute kidney injury nor prior chronic kidney disease. In contrast, more than one quarter of our control cohort had a history of preexisting chronic kidney disease.</p> <a class="article-section-id-anchor" id="24832885"></a> <p class="para">Injury to the kidney, especially that necessitating acute dialysis, seems to independently predispose a patient to long-term dialysis, even among those who are free of dialysis at hospital discharge. This parallels basic science data that demonstrate the long-term effects of ischemia-reperfusion injury on the loss of the renal vasculature and progressive renal fibrosis.<sup><a href="#ref-joc90093-23" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">23</a></sup><sup>,<a href="#ref-joc90093-24" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">24</a></sup> Acute kidney injury may induce irreversible chronic kidney damage in patients with previously healthy kidneys, and accelerate kidney disease progression among patients with preexisting chronic kidney disease.</p> <a class="article-section-id-anchor" id="24832886"></a> <p class="para">In contrast to other studies,<sup><a href="#ref-joc90093-22" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">22</a></sup> we found that a prior history of acute kidney injury and dialysis was not independently associated with long-term mortality (HR, 0.95; 95% CI, 0.89-1.02). Indeed, there was a surprising trend that suggested a lower associated risk of death in patients with prior acute kidney injury and dialysis. There are 2 likely explanations for this finding. First, although our comparator group comprised individuals without acute kidney injury (in whom acute dialysis was not indicated), those with acute kidney injury who received dialysis may have been a selected group of individuals who were more likely to survive. The tendency to administer life-saving therapies to those most likely to have a favorable prognosis has been demonstrated in other settings. For example, patients at lowest risk for cardiovascular disease and the highest likelihood of survival were prescribed efficacious drug therapies more commonly than those at higher risk.<sup><a href="#ref-joc90093-25" class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references">25</a></sup> Second, as mentioned previously, approximately 7% of the 4066 survivors with acute kidney injury and dialysis were excluded from the data analyses due to a lack of at least 1 appropriate match. These individuals exhibited a higher mortality rate over time. Had these individuals been included in the final analyses, the small nonsignificant trend toward reduced mortality would likely have been further diminished.</p> <a class="article-section-id-anchor" id="24832887"></a> <p class="para">Our findings expand on prior knowledge to provide clinicians with new information about the long-term effect of acute kidney injury that arises during a hospitalization. First, if affected patients survive to hospital discharge, then they remain at high risk of needing dialysis over the next 3 to 5 years. Patients who survive a hospitalization complicated by acute kidney injury requiring dialysis may benefit from specialized care to address complications of chronic kidney disease, and also from concerted efforts to prevent progression to chronic dialysis. At the same time, their high mortality rate is similar to hospitalized patients without acute kidney injury or need for dialysis. Hence, an episode of acute kidney injury requiring in-hospital dialysis may not be an independent contributing factor to long-term survival.</p> <a class="article-section-id-anchor" id="24832888"></a> <div class="h3 cb section-type-acknowledgements has-back-to-top"> <a href="#top" class="section-jump-link back-to-top" data-tab-toggle=".tab-nav-full-text">Back to top</a> <div class="heading-text thm-col sb-sc"> Article Information </div> </div> <p class="authorInfoSection"><strong>Corresponding Author:</strong> Ron Wald, MDCM, MPH, FRCPC, Division of Nephrology, St Michael's Hospital, 61 Queen St East, 9-140, Toronto, ON M5C 2T2, Canada (<a href="mailto:waldr@smh.toronto.on.ca" target="_blank">waldr@smh.toronto.on.ca</a>).</p><p class="para"><strong>Author Contributions:</strong> Drs Luo and Li had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.</p><p class="para"><em>Study concept and design</em>: Wald, Quinn, Scales, Mamdani, Ray.</p><p class="para"><em>Analysis and interpretation of data</em>: Wald, Luo, Li.</p><p class="para"><em>Drafting of the manuscript</em>: Wald, Ray.</p><p class="para"><em>Critical revision of the manuscript for important intellectual content</em>: Wald, Quinn, Luo, Li, Scales, Mamdani.</p><p class="para"><em>Statistical analysis</em>: Wald, Luo, Li, Scales, Ray.</p><p class="para"><em>Obtained funding</em>: Wald.</p><p class="para"><em>Administrative, technical, or material support</em>: Wald.</p><p class="para"><em>Study supervision</em>: Mamdani, Ray.</p><div class="findDisclosureSection"><p class="para"><strong>Financial Disclosures:</strong> None reported.</p></div><p class="para"><strong>Funding/Support:</strong> This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care; and a New Staff Dean's Grant from the University of Toronto Faculty of Medicine. Dr Scales reports support from a Canadian Institutes of Health Research New Investigator Award. Dr Wald reports receipt of an RCT Mentoring Program Award from the Canadian Institutes of Health Research and an unrestricted grant from Amgen. Dr Quinn reports support from a Canadian Institutes of Health Research Institute of Health Services and Policy Research Fellowship. Dr Ray reports support from a Canadian Institutes of Health Research New Investigator Award.</p><p class="para"><strong>Role of the Sponsor:</strong> The Ontario Ministry of Health and Long-Term Care and the University of Toronto Faculty of Medicine had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.</p><p class="para"><strong>Other members of the University of Toronto Acute Kidney Injury Research Group:</strong> Stephen Lapinsky, MD (Mt Sinai Hospital); Karen Burns, MD, MSc, and Jan Friedrich, MD, MSc, DPhil (St Michael's Hospital); Neill Adhikari, MDCM, MSc, Michelle Hladunewich, MD, MSc, and Sheldon Tobe, MD (Sunnybrook Health Sciences Centre); and Robert Richardson, MD (University Health Network), Toronto, Ontario, Canada.</p><p class="para"><strong>Disclaimer:</strong> The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.</p><p class="para"><strong>Previous Presentations:</strong> Presented in part at the 2008 American Society of Nephrology Renal Week (Philadelphia, Pennsylvania).</p><p class="para"><strong>Additional Contributions:</strong> We are grateful for the thoughtful input provided by Ahmed Bayoumi, MD, Tara Gomes, MHSc, Michael Paterson, MSc, and Jan Hux, MD. They received no compensation for their contributions.</p> <a class="article-section-id-anchor" id="24832889"></a> <div class="h3 cb section-type-references "> <div class="heading-text thm-col sb-sc"> References </div> </div> <div class="references"><div class="reference"><a class="reference-number" id="ref-joc90093-1">1.</a><div class="reference-content">Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ.French Study Group on Acute Renal Failure. Acute renal failure in intensive care units–causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study: French Study Group on Acute Renal Failure. <I xmlns:helper="urn:XsltStringHelper"> Crit Care Med</I>. 1996;24(2):192-1988605788<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8605788" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20renal%20failure%20in%20intensive%20care%20units%E2%80%93causes%2C%20outcome%2C%20and%20prognostic%20factors%20of%20hospital%20mortality%3B%20a%20prospective%2C%20multicenter%20study%3A%20French%20Study%20Group%20on%20Acute%20Renal%20Failure.&author=FG%20Brivet&author=DJ%20Kleinknecht&author=P%20Loirat&author=PJ%20Landais&publication_year=&journal=Crit%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00003246-199602000-00003" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00003246-199602000-00003" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-2">2.</a><div class="reference-content">de Mendonça A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. <I xmlns:helper="urn:XsltStringHelper"> Intensive Care Med</I>. 2000;26(7):915-92110990106<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/10990106" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20renal%20failure%20in%20the%20ICU%3A%20risk%20factors%20and%20outcome%20evaluated%20by%20the%20SOFA%20score.&author=A%20de Mendonça&author=JL%20Vincent&author=PM%20Suter&publication_year=&journal=Intensive%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s001340051281" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1007/s001340051281" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-3">3.</a><div class="reference-content">Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. <I xmlns:helper="urn:XsltStringHelper"> J Am Soc Nephrol</I>. 2005;16(11):3365-337016177006<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16177006" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20kidney%20injury%2C%20mortality%2C%20length%20of%20stay%2C%20and%20costs%20in%20hospitalized%20patients.&author=GM%20Chertow&author=E%20Burdick&author=M%20Honour&author=JV%20Bonventre&author=DW%20Bates&publication_year=&journal=J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1681/ASN.2004090740" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1681/ASN.2004090740" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-4">4.</a><div class="reference-content">Liangos O, Wald R, O’Bell J, Price L, Pereira B, Jaber B. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. <I xmlns:helper="urn:XsltStringHelper"> Clin J Am Soc Nephrol</I>. 2006;1(1):43-5117699189<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/17699189" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Epidemiology%20and%20outcomes%20of%20acute%20renal%20failure%20in%20hospitalized%20patients%3A%20a%20national%20survey.&author=O%20Liangos&author=R%20Wald&author=J%20O’Bell&author=L%20Price&author=B%20Pereira&author=B%20Jaber&publication_year=&journal=Clin%20J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.2215/CJN.00220605" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.2215/CJN.00220605" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-5">5.</a><div class="reference-content">McCarthy JT. Prognosis of patients with acute renal failure in the intensive-care unit: a tale of two eras. <I xmlns:helper="urn:XsltStringHelper"> Mayo Clin Proc</I>. 1996;71(2):117-1268577185<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/8577185" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prognosis%20of%20patients%20with%20acute%20renal%20failure%20in%20the%20intensive-care%20unit%3A%20a%20tale%20of%20two%20eras.&author=JT%20McCarthy&publication_year=&journal=Mayo%20Clin%20Proc&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.4065/71.2.117" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.4065/71.2.117" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-6">6.</a><div class="reference-content">Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. <I xmlns:helper="urn:XsltStringHelper"> Crit Care Med</I>. 2001;29(10):1910-191511588450<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/11588450" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Epidemiology%2C%20management%2C%20and%20outcome%20of%20severe%20acute%20renal%20failure%20of%20critical%20illness%20in%20Australia.&author=W%20Silvester&author=R%20Bellomo&author=L%20Cole&publication_year=&journal=Crit%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00003246-200110000-00010" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00003246-200110000-00010" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-7">7.</a><div class="reference-content">Metnitz PG, Krenn CG, Steltzer H, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. <I xmlns:helper="urn:XsltStringHelper"> Crit Care Med</I>. 2002;30(9):2051-205812352040<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12352040" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Effect%20of%20acute%20renal%20failure%20requiring%20renal%20replacement%20therapy%20on%20outcome%20in%20critically%20ill%20patients.&author=PG%20Metnitz&author=CG%20Krenn&author=H%20Steltzer&publication_year=&journal=Crit%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1097/00003246-200209000-00016" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1097/00003246-200209000-00016" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-8">8.</a><div class="reference-content">Morgera S, Kraft AK, Siebert G, Luft FC, Neumayer HH. Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. <I xmlns:helper="urn:XsltStringHelper"> Am J Kidney Dis</I>. 2002;40(2):275-27912148099<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/12148099" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Long-term%20outcomes%20in%20acute%20renal%20failure%20patients%20treated%20with%20continuous%20renal%20replacement%20therapies.&author=S%20Morgera&author=AK%20Kraft&author=G%20Siebert&author=FC%20Luft&author=HH%20Neumayer&publication_year=&journal=Am%20J%20Kidney%20Dis&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1053/ajkd.2002.34505" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1053/ajkd.2002.34505" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-9">9.</a><div class="reference-content">Uchino S, Kellum JA, Bellomo R, et al; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. <I xmlns:helper="urn:XsltStringHelper"> JAMA</I>. 2005;294(7):813-81816106006<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16106006" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20renal%20failure%20in%20critically%20ill%20patients%3A%20a%20multinational%2C%20multicenter%20study.&author=S%20Uchino&author=JA%20Kellum&author=R%20Bellomo&publication_year=&journal=JAMA&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.294.7.813" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jama.294.7.813" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-10">10.</a><div class="reference-content">Schiffl H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. <I xmlns:helper="urn:XsltStringHelper"> Nephrol Dial Transplant</I>. 2006;21(5):1248-125216449291<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16449291" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Renal%20recovery%20from%20acute%20tubular%20necrosis%20requiring%20renal%20replacement%20therapy%3A%20a%20prospective%20study%20in%20critically%20ill%20patients.&author=H%20Schiffl&publication_year=&journal=Nephrol%20Dial%20Transplant&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1093/ndt/gfk069" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1093/ndt/gfk069" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-11">11.</a><div class="reference-content">Mehta RL, Pascual MT, Soroko S, et al; Program to Improve Care in Acute Renal Disease. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. <I xmlns:helper="urn:XsltStringHelper"> Kidney Int</I>. 2004;66(4):1613-162115458458<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15458458" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Spectrum%20of%20acute%20renal%20failure%20in%20the%20intensive%20care%20unit%3A%20the%20PICARD%20experience.&author=RL%20Mehta&author=MT%20Pascual&author=S%20Soroko&publication_year=&journal=Kidney%20Int&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1111/j.1523-1755.2004.00927.x" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1111/j.1523-1755.2004.00927.x" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-12">12.</a><div class="reference-content">Palevsky PM, Zhang JH, O'Connor TZ, et al; VA/NIH Acute Renal Failure Trial Network. Intensity of renal support in critically ill patients with acute kidney injury. <I xmlns:helper="urn:XsltStringHelper"> N Engl J Med</I>. 2008;359(1):7-2018492867<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/18492867" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Intensity%20of%20renal%20support%20in%20critically%20ill%20patients%20with%20acute%20kidney%20injury.&author=PM%20Palevsky&author=JH%20Zhang&author=TZ%20O'Connor&publication_year=&journal=N%20Engl%20J%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa0802639" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1056/NEJMoa0802639" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-13">13.</a><div class="reference-content">Bagshaw SM, Laupland KB, Doig CJ, et al. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. <I xmlns:helper="urn:XsltStringHelper"> Crit Care</I>. 2005;9(6):R700-R70916280066<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16280066" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Prognosis%20for%20long-term%20survival%20and%20renal%20recovery%20in%20critically%20ill%20patients%20with%20severe%20acute%20renal%20failure%3A%20a%20population-based%20study.&author=SM%20Bagshaw&author=KB%20Laupland&author=CJ%20Doig&publication_year=&journal=Crit%20Care&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1186/cc3879" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1186/cc3879" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-14">14.</a><div class="reference-content">Schiffl H, Fischer R. Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. <I xmlns:helper="urn:XsltStringHelper"> Nephrol Dial Transplant</I>. 2008;23(7):2235-224118408072<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/18408072" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Five-year%20outcomes%20of%20severe%20acute%20kidney%20injury%20requiring%20renal%20replacement%20therapy.&author=H%20Schiffl&author=R%20Fischer&publication_year=&journal=Nephrol%20Dial%20Transplant&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1093/ndt/gfn182" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1093/ndt/gfn182" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-15">15.</a><div class="reference-content">Ahlström A, Tallgren M, Peltonen S, Rasanen P, Pettila V. Survival and quality of life of patients requiring acute renal replacement therapy. <I xmlns:helper="urn:XsltStringHelper"> Intensive Care Med</I>. 2005;31(9):1222-122816049711<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16049711" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Survival%20and%20quality%20of%20life%20of%20patients%20requiring%20acute%20renal%20replacement%20therapy.&author=A%20Ahlström&author=M%20Tallgren&author=S%20Peltonen&author=P%20Rasanen&author=V%20Pettila&publication_year=&journal=Intensive%20Care%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1007/s00134-005-2681-6" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1007/s00134-005-2681-6" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-16">16.</a><div class="reference-content">Scales DC, Guan J, Martin CM, Redelmeier DA. Administrative data accurately identified intensive care unit admissions in Ontario. <I xmlns:helper="urn:XsltStringHelper"> J Clin Epidemiol</I>. 2006;59(8):802-80716828673<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16828673" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Administrative%20data%20accurately%20identified%20intensive%20care%20unit%20admissions%20in%20Ontario.&author=DC%20Scales&author=J%20Guan&author=CM%20Martin&author=DA%20Redelmeier&publication_year=&journal=J%20Clin%20Epidemiol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/j.jclinepi.2005.11.015" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/j.jclinepi.2005.11.015" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-17">17.</a><div class="reference-content">Rubin DB. Estimating causal effects from large data sets using propensity scores. <I xmlns:helper="urn:XsltStringHelper"> Ann Intern Med</I>. 1997;127(8 pt 2):757-7639382394<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/9382394" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Estimating%20causal%20effects%20from%20large%20data%20sets%20using%20propensity%20scores.&author=DB%20Rubin&publication_year=&journal=Ann%20Intern%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.7326/0003-4819-127-8_Part_2-199710151-00064" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.7326/0003-4819-127-8_Part_2-199710151-00064" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-18">18.</a><div class="reference-content">Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. <I xmlns:helper="urn:XsltStringHelper"> J Chronic Dis</I>. 1987;40(5):373-3833558716<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/3558716" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=A%20new%20method%20of%20classifying%20prognostic%20comorbidity%20in%20longitudinal%20studies%3A%20development%20and%20validation.&author=ME%20Charlson&author=P%20Pompei&author=KL%20Ales&author=CR%20MacKenzie&publication_year=&journal=J%20Chronic%20Dis&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1016/0021-9681(87)90171-8" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1016/0021-9681(87)90171-8" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-19">19.</a><div class="reference-content">Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. <I xmlns:helper="urn:XsltStringHelper"> N Engl J Med</I>. 2004;351(6):543-55115295047<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15295047" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Rates%20of%20hyperkalemia%20after%20publication%20of%20the%20Randomized%20Aldactone%20Evaluation%20Study.&author=DN%20Juurlink&author=MM%20Mamdani&author=DS%20Lee&publication_year=&journal=N%20Engl%20J%20Med&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1056/NEJMoa040135" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1056/NEJMoa040135" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-20">20.</a><div class="reference-content">Redelmeier D, Scales D, Kopp A. Beta blockers for elective surgery in elderly patients: population based, retrospective cohort study. <I xmlns:helper="urn:XsltStringHelper"> BMJ</I>. 2005;331(7522):93216210252<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16210252" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Beta%20blockers%20for%20elective%20surgery%20in%20elderly%20patients%3A%20population%20based%2C%20retrospective%20cohort%20study.&author=D%20Redelmeier&author=D%20Scales&author=A%20Kopp&publication_year=&journal=BMJ&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1136/bmj.38603.746944.3A" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1136/bmj.38603.746944.3A" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-21">21.</a><div class="reference-content">Waikar SS, Wald R, Chertow GM, et al. Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. <I xmlns:helper="urn:XsltStringHelper"> J Am Soc Nephrol</I>. 2006;17(6):1688-169416641149<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/16641149" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Validity%20of%20International%20Classification%20of%20Diseases%2C%20Ninth%20Revision%2C%20Clinical%20Modification%20Codes%20for%20Acute%20Renal%20Failure.&author=SS%20Waikar&author=R%20Wald&author=GM%20Chertow&publication_year=&journal=J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1681/ASN.2006010073" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1681/ASN.2006010073" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-22">22.</a><div class="reference-content">Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of ESRD among elderly. <I xmlns:helper="urn:XsltStringHelper"> J Am Soc Nephrol</I>. 2009;20(1):223-22819020007<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/19020007" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Acute%20kidney%20injury%20increases%20risk%20of%20ESRD%20among%20elderly.&author=A%20Ishani&author=JL%20Xue&author=J%20Himmelfarb&publication_year=&journal=J%20Am%20Soc%20Nephrol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1681/ASN.2007080837" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1681/ASN.2007080837" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-23">23.</a><div class="reference-content">Basile DP, Donohoe D, Roethe K, Osborn JL. Renal ischemic injury results in permanent damage to peritubular capillaries and influences long-term function. <I xmlns:helper="urn:XsltStringHelper"> Am J Physiol Renal Physiol</I>. 2001;281(5):F887-F89911592947<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/11592947" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Renal%20ischemic%20injury%20results%20in%20permanent%20damage%20to%20peritubular%20capillaries%20and%20influences%20long-term%20function.&author=DP%20Basile&author=D%20Donohoe&author=K%20Roethe&author=JL%20Osborn&publication_year=&journal=Am%20J%20Physiol%20Renal%20Physiol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-24">24.</a><div class="reference-content">Spurgeon KR, Donohoe DL, Basile DP. Transforming growth factor-beta in acute renal failure: receptor expression, effects on proliferation, cellularity, and vascularization after recovery from injury. <I xmlns:helper="urn:XsltStringHelper"> Am J Physiol Renal Physiol</I>. 2005;288(3):F568-F57715536165<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15536165" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Transforming%20growth%20factor-beta%20in%20acute%20renal%20failure%3A%20receptor%20expression%2C%20effects%20on%20proliferation%2C%20cellularity%2C%20and%20vascularization%20after%20recovery%20from%20injury.&author=KR%20Spurgeon&author=DL%20Donohoe&author=DP%20Basile&publication_year=&journal=Am%20J%20Physiol%20Renal%20Physiol&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1152/ajprenal.00330.2004" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1152/ajprenal.00330.2004" xmlns:helper="urn:XsltStringHelper"> </span></div></div><div class="reference"><a class="reference-number" id="ref-joc90093-25">25.</a><div class="reference-content">Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. <I xmlns:helper="urn:XsltStringHelper"> JAMA</I>. 2004;291(15):1864-187015100205<a class="pubmed-link" href="https://www.ncbi.nlm.nih.gov/pubmed/15100205" target="_blank" xmlns:helper="urn:XsltStringHelper">PubMed</a><a class="google-scholar-ref-link" href="https://scholar.google.com/scholar_lookup?title=Lipid-lowering%20therapy%20with%20statins%20in%20high-risk%20elderly%20patients%3A%20the%20treatment-risk%20paradox.&author=DT%20Ko&author=M%20Mamdani&author=DA%20Alter&publication_year=&journal=JAMA&volume=&pages=" target="_blank" xmlns:helper="urn:XsltStringHelper">Google Scholar</a><a href="https://doi.org/10.1001/jama.291.15.1864" class="crossref-doi" target="_blank" xmlns:helper="urn:XsltStringHelper">Crossref</a><span class="inst-open-url-holders" data-targetId="10.1001/jama.291.15.1864" xmlns:helper="urn:XsltStringHelper"> </span></div></div></div> </div> </div> <div class="movable-ad bta"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_textbreak_bta_dual"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_textbreak_bta_dual" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":8,"adSection":"textbreak","adPosition":"bta","fromGoogle":false},"dynamicParameters":{}}"></div> </div> </div> </div> </div> <div class="hidden-jobs-ad hide"> <div class="widget-WidgetLoader widget-instance-AMA_JobsAd"> <div class="SCM-SharedWidgets-AsyncJobsAdLoader" data-url="/AMA/JobsAd/AMA_JobsAd" data-params="{"parameters":{"SiteId":3},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <script> var App = App || {}; App.ArticleSplitScreen = App.ArticleSplitScreen || {}; App.ArticleSplitScreen.siteName = 'jama'; App.ArticleSplitScreen.siteId = 3; App.ArticleSplitScreen.journalId = 67; App.ArticleSplitScreen.adDisplay = 'ArticleContentsSkyBox'; App.ArticleSplitScreen.adSection = "scholarly"; App.ArticleSplitScreen.adPosition = "contab"; App.ArticleSplitScreen.controlId = "AMA_AdTag_Contents_Skybox"; App.ArticleSplitScreen.fromGoogle = "False"; App.ArticleSplitScreen.slotLocationOverride = "50"; </script> </div> </div> </section> <section id="secFooterControl" class="master-footer"> <script> var App = App || {}; function scmByClass(className) { return document.getElementsByClassName(className); } function scmById(id) { return document.getElementById(id); } function scmquery(selector) { return document.querySelector(selector); } function queryAll(selector) { return document.querySelectorAll(selector); } function isTrueString(string) { if (typeof string === 'string') { return string.toLowerCase() === 'true'; } return undefined; } function updateViewportDimensions() { var w = window, d = document, e = d.documentElement, g = d.getElementsByTagName('body')[0], x = w.innerWidth || e.clientWidth || g.clientWidth, y = w.innerHeight || e.clientHeight || g.clientHeight; return { width: x, height: y }; } var viewport = updateViewportDimensions(); var debounce = function (func, wait, immediate) { var timeout; return function () { var context = this, args = arguments; var later = function () { timeout = null; if (!immediate) func.apply(context, args); }; var callNow = immediate && !timeout; clearTimeout(timeout); timeout = setTimeout(later, wait); if (callNow) func.apply(context, args); }; }; (function (App) { App.mobileUpperBreakpoint = 767; App.mobileAltBreakpoint = 640; App.mobileMinBreakpoint = 547; App.tabletUpperBreakpoint = 1023; function setVariables() { viewport = updateViewportDimensions(); App.isMobile = (viewport.width <= App.mobileUpperBreakpoint); App.isMobileAlt = (viewport.width <= App.mobileAltBreakpoint); App.isTablet = (viewport.width > App.mobileUpperBreakpoint && viewport.width <= App.tabletUpperBreakpoint); App.isTabletDown = (viewport.width <= App.tabletUpperBreakpoint); App.isDesktop = (viewport.width > App.tabletUpperBreakpoint); App.activeViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; } setVariables(); App.cachedViewport = App.isMobile ? 'small' : App.isTablet ? 'med' : 'large'; App.isAnyArticle = !!(scmByClass('widget-ArticleFullView').length || scmByClass('pg_abstract').length || scmByClass('widget-MagazineView').length || scmByClass('widget-ChannelsMagazineView').length); App.isSplitScreen = !!scmByClass('widget-ArticleFullView').length; App.isArticleRedesign = !!scmByClass('widget-ArticleWrapper').length; App.isAbstract = !!scmByClass('pg_abstract').length; App.isMag = !!(scmByClass('widget-MagazineView').length); App.isChannel = !!(scmByClass('channel-site').length); App.isChannelMag = !!(scmByClass('widget-ChannelsMagazineView').length); App.isFreeArticle = !!(scmquery('.widget-ArticleTopInfo .free-access') || scmquery('.widget-ArticleTopInfo .open-access') || scmquery('.widget-ArticleTopInfo .icon-free') || scmquery('.widget-ChannelsMagazineView .free-access')); App.isTollFreeAccess = false; App.isIssue = !!scmByClass('pg_issue').length || !!scmByClass('pg_newonline').length || !!scmByClass('pg_currentissue').length || !!scmByClass('pg_pastissues').length; App.isNewOnline = !!scmByClass('pg_newonline').length; App.isCurrentIssue = !!scmByClass('pg_currentissue').length; App.isPastIssues = !!scmByClass('pg_pastissues').length; App.isJournal = !!scmByClass('pg_journal').length; App.isNetworkHome = !!scmByClass('pg_index').length; App.isSearch = !!scmByClass('pg_searchresults').length; App.isAdvancedSearch = !!scmByClass('pg_advancedsearch').length; App.isPlayer= !!scmByClass('pg_multimediaplayer').length; App.isSelfServe = !!scmByClass('pg_sspage').length; App.isCmsPage = !!scmByClass('pg_cmspage').length; App.isMyAccount = !!scmByClass('pg_myaccount').length; App.supportsFlexbox = !!scmByClass('flexbox').length; App.isCollection = !!scmByClass('pg_collection').length; App.isPaidUser = isTrueString(scmById('hfAppIsPaidUser').getAttribute('value')); App.isMember = isTrueString(scmById('hfAppIsMember').getAttribute('value')); App.isIndividual = isTrueString(scmById('hfAppIsIndividual').getAttribute('value')); App.hasAccess = isTrueString(scmById('hfAppHasAccess').getAttribute('value')); App.isReferredFromGoogle = isTrueString(scmById('hfAppIsReferredFromGoogle').getAttribute('value')); var subscribedTo = scmById('hfAppSubscribedTo').getAttribute('value'); App.userSubscribedTo = subscribedTo ? subscribedTo.split(',') : undefined; App.isLucy = isTrueString(scmById('hfAppIsLucy').getAttribute('value')); App.currentJournalCount = 27; App.isChannelPage = !!(scmByClass('channels-page')); App.updateAppVariables = debounce(function () { setVariables(); }, 50, false); })(App); </script> <div class="footer-ad-wrapper"> <div id="BodyContent_Footer_divAds" class="footer-ad desktop-only"> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_AnchorboardAd_btf"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_AnchorboardAd_btf" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":11,"adSection":"scholarly","adPosition":"btf","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> </div> <div class="ad-riser-wrap desktop-only"> <div class="ad-riser--dismiss t-c">X</div> <div class="widget-WidgetLoader widget-instance-AMA_AdTag_Riser"> <div class="SCM-SharedWidgets-AsyncAdLoader" data-url="/AMA/AdTag/AMA_AdTag_Riser" data-params="{"parameters":{"siteName":"jama","siteId":3,"journalId":67,"adDisplay":12,"adSection":"scholarly","adPosition":"Riser","fromGoogle":false},"dynamicParameters":{"localParams":"[REPLACE_WITH_LOCAL]"}}"></div> </div> </div> <div class="footer-wrap"> <footer class="footer" id="footer"> <div id="footer-microsite" class="footer-microsite"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Left" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> @media (min-width: 1024px) {.split-screen .footer-microsite-contents {border-bottom:0 !important;}} .footer-microsite-contents {margin-bottom:1em;width:100%;} .footer-network-other .link-apps:before {width: 23px;} .footer-network-other .link-institutions-librarians:before {width: 23px;} .jn-ss-footer-border-top {border-top:1px solid #555;padding-top:15px;} .jn-ss-footer-border-bottom {border-bottom:1px solid #555;padding-bottom:10px;padding-right:3px;} </style> <div class="footer-heading-wrap"> <h3 id="BodyContent_Footer_h3SiteName" class="footer-heading is-b footer-microsite-heading" data-mobile-tog-target=".footer-microsite-links-wrap">JAMA</h3> </div> <div class="footer-microsite-links-wrap"> <div class="footer-microsite-contents jn-ss-footer-border-bottom"> <h4 id="BodyContent_Footer_ContentHeader" class="footer-subheading">Content</h4> <a href="/journals/jama">Home</a> <a href="/journals/jama/newonline">New Online</a> <a href="/journals/jama/currentissue">Current Issue</a> </div> <div class="footer-microsite-contents jn-ss-footer-border-bottom"> <h4 class="footer-subheading">Podcasts</h4> <a href="/journals/jama/pages/covid-19-interviews#audio">Coronavirus (COVID-19) Q&A</a> <a href="/journals/jama/pages/jama-clinical-reviews">Clinical Reviews</a> <a href="/journals/jama/pages/jama-editors-summary">Editors' Summary</a> <a href="/journals/jama/pages/jama-medical-news">Medical News</a> <a href="/journals/jama/pages/jama-author-interviews">Author Interviews</a> <a href="/journals/jama/pages/jamaevidence-jama-guide-to-statistics-and-methods">JAMAevidence: <em>JAMA Guide to Statistics and Methods</em></a> <a href="/journals/jama/pages/jamaevidence-the-rational-clinical-examination">JAMAevidence: The Rational Clinical Examination</a> <a href="/journals/jama/pages/jamaevidence-users-guides-to-the-medical-literature">JAMAevidence: Users' Guides to the Medical Literature</a> </div> <div class="footer-microsite-services cf"> <h4 id="BodyContent_Footer_ServiceHeader" class="footer-subheading">Journal Information</h4> <a href="/journals/jama/pages/for-authors">For Authors</a> <a href="/journals/jama/pages/jama-editors">JAMA Editors</a> <a href="/journals/jama/editors-and-publishers">Editors & Publishers</a> <a href="/pages/rss">RSS</a> <a href="/journals/jama/pages/contact-us">Contact Us</a> </div> <div class="footer-network-other jn-ss-footer-border-bottom"> <a href="https://edhub.ama-assn.org/jn-learning" class="link-network-other is-b link-learning">JN Learning / CME</a> <a href="https://store.jamanetwork.com" class="link-network-other is-b link-store" target="_blank">Store</a> <a href="/pages/apps" class="link-network-other is-b link-mobile" target="_blank">Apps</a> <a href="https://careers.jamanetwork.com/" class="link-network-other is-b link-jobs" target="_blank">Jobs</a> <a href="/pages/resources-for-librarians" class="link-network-other is-b link-institutions-librarians" target="_blank">Institutions</a> <a href="/pages/reprints-and-permissions" class="link-network-other is-b link-reprints-permissions">Reprints & Permissions</a> </div> <div id="BodyContent_Footer_divSubscribe" class="footer-microsite-subscribe"> <img src="//cdn.jamanetwork.com/UI/app/img/covers/jama.jpg" class="subscribe-image" alt="Journal Cover"> <div class="subscribe-meta"> <h4 class="subscribe-heading footer-subheading">Subscribe</h4> <a href="https://store.jamanetwork.com/productDetails.aspx?productcodeID=64" class="subscribe-submit btn">Go</a> </div> </div> </div> </div> <div id="footer-network" class="footer-network"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Middle" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-network-sites {width: 62.85542%;} .footer-network-info {width: 35.93976%} .jn-ss-subheading-mt {margin-top: 1.5em;} .jn-registered:after {content: "\00AE";font-size: 50%;vertical-align: top;} .jn-trademark:after {content: "\2122";font-size: 50%;vertical-align: top;} .nav-logo-cme-signin-container .nav-logo .site-logo img { min-width:50px;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b jn-registered" data-mobile-tog-target=".footer-network-links-wrap"><strong>JAMA</strong> Network</h3> </div> <div class="footer-network-links-wrap"> <div class="footer-network-sites"> <div class="internal"> <h4 id="BodyContent_Footer_JournalHeader" class="footer-subheading">Publications</h4> <a href="/journals/jama">JAMA</a> <a href="/journals/jamanetworkopen" target="_blank">JAMA Network Open</a> <a href="/journals/jamacardiology">JAMA Cardiology</a> <a href="/journals/jamadermatology">JAMA Dermatology</a> <a href="/journals/jama-health-forum">JAMA Health Forum</a> <a href="/journals/jamainternalmedicine">JAMA Internal Medicine</a> <a href="/journals/jamaneurology">JAMA Neurology</a> <a href="/journals/jamaoncology">JAMA Oncology</a> <a href="/journals/jamaophthalmology">JAMA Ophthalmology</a> <a href="/journals/jamaotolaryngology">JAMA Otolaryngology–Head & Neck Surgery</a> <a href="/journals/jamapediatrics">JAMA Pediatrics</a> <a href="/journals/jamapsychiatry">JAMA Psychiatry</a> <a href="/journals/jamasurgery">JAMA Surgery</a> <a href="/journals/archneurpsyc">Archives of Neurology & Psychiatry (1919-1959)</a> </div> <div class="external"> <h4 class="footer-subheading">Sites</h4> <div id="BodyContent_Footer_ssFooterSiteMenu"> <div class="selfServe"> <a target="_blank" href="https://sites.jamanetwork.com/art-and-images-in-psychiatry/">Art and Images in Psychiatry</a> <a target="_blank" href="/journals/jama/pages/2023-most-viewed-jama">Best of the JAMA Network</a> <a target="_blank" href="/channels/caring-for-the-critically-ill-patient">Caring for the Critically Ill Patient</a> <a target="_blank" href="/journals/jama/pages/crosswords">Clinical Crosswords from JAMA</a> <a target="_blank" href="/journals/jama/pages/coronavirus-alert">Coronavirus Resource Center</a> <a target="_blank" href="https://ebm.jamanetwork.com/index.html">Evidence-Based Medicine: An Oral History</a> <a target="_blank" href="/pages/fishbein-fellowship">Fishbein Fellowship</a> <a target="_blank" href="/channels/genomics/">Genomics and Precision Health</a> <a target="_blank" href="/pages/health-and-the-2024-us-election">Health and the 2024 US Election</a> <a target="_blank" href="/channels/hypertension">Hypertension</a> <a target="_blank" href="/channels/health-forum/archive">JAMA Forum Archive</a> <a target="_blank" href="https://sites.jamanetwork.com/audio">JAMA Network Audio</a> <a target="_blank" href="/pages/video">JAMA Network Video</a> <a target="_blank" href="/pages/conferences">JAMA Network Conferences </a> <a target="_blank" href="/channels/ai">JAMA+ AI</a> <a target="_blank" href="/pages/jama-summit">JAMA Summit </a> <a target="_blank" href="/journals/jamasurgery/pages/statistics-and-methods">JAMA Surgery Guide to Statistics and Methods</a> <a target="_blank" href="/channels/medical-news">Medical News</a> <a target="_blank" href="/channels/monkeypox">Mpox (Monkeypox)</a> <a target="_blank" href="https://sites.jamanetwork.com/research-ethics/">Research Ethics</a> <a target="_blank" href="/pages/collections">Topics and Collections</a> <a target="_blank" href="/pages/visual-abstracts">Visual Abstracts</a> <a target="_blank" href="/channels/war">War and Health</a> <a target="_blank" href="/channels/womens-health">Women's Health</a> <h4 class="footer-subheading jn-ss-subheading-mt">Featured Articles</h4> <a href="/journals/jama/fullarticle/2781397">CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic</a> <a href="/journals/jama/fullarticle/2808296">Creation and Adoption of Large Language Models in Medicine</a> <a href="/journals/jamaoncology/fullarticle/2787350">Global Burden of Cancer, 2010-2019</a> <a href="/journals/jama/fullarticle/2797443">Global Burden of Long COVID</a> <a href="/journals/jamadermatology/fullarticle/2790344">Global Burden of Melanoma</a> <a href="/journals/jamadermatology/fullarticle/2787350">Global Burden of Skin Diseases, 1990-2017</a> <a href="/journals/jamaneurology/fullarticle/2793874">Global Disparities in Parkinson Disease</a> <a href="/journals/jama/fullarticle/2799547">Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension</a> <a href="/journals/jamapsychiatry/fullarticle/2799486">Mass Violence and the Complex Spectrum of Mental Illness and Mental Functioning</a> <a href="/journals/jamapsychiatry/fullarticle/2793903">Neuropsychiatry Sequelae of COVID-19</a> <a href="/journals/jamaneurology/fullarticle/2810313">A New Framework for Dementia Nomenclature</a> <a href="/journals/jama/fullarticle/2800656">Organization and Performance of US Health Systems</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Pharmacy Benefit Managers: History, Business Practices, Economics, and Policy</a> <a href="/journals/jama-health-forum/fullarticle/2791195">Promoting EDI in Genetics Research</a> <a href="/journals/jamacardiology/fullarticle/2781972">PTSD and Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2810754">Red Blood Cell Transfusion: 2023 AABB International Guidelines</a> <a href="/journals/jamapediatrics/fullarticle/2797600">Reimagining Children’s Rights in the US</a> <a href="/journals/jama/fullarticle/2794049">Spirituality in Serious Illness and Health</a> <a href="/journals/jama/fullarticle/2796374">The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity</a> <h4 class="footer-subheading jn-ss-subheading-mt">USPSTF Recommendation Statements</h4> <a href="/journals/jama/fullarticle/2779985">Screening for Colorectal Cancer</a> <a href="/journals/jama/fullarticle/2779190">Screening for Hypertension</a> <a href="/journals/jama/fullarticle/2777244">Screening for Lung Cancer</a> <a href="/journals/jama/fullarticle/2796244">Screening for Prediabetes and Type 2 Diabetes In Children</a> <a href="/journals/jama/fullarticle/2783414">Screening for Prediabetes and Type 2 Diabetes In Adults</a> <a href="/journals/jama/fullarticle/2795521">Statins for Primary Prevention of Cardiovascular Disease</a> <a href="/journals/jama/fullarticle/2793446">Vitamin and Mineral Supplements for Primary Prevention of of Cardiovascular Disease and Cancer</a> <h4 class="footer-subheading jn-ss-subheading-mt">Blogs</h4> <a target="_blank" href="https://amastyleinsider.com/">AMA Style Insider</a> </div> </div> </div> </div> <div id="footer-network-info" class="footer-network-info"> <div class="information-for-links"> <h4 id="BodyContent_Footer_InfoHeader" class="footer-subheading">Information</h4> <a href="/pages/for-authors">For Authors</a> <a href="/pages/resources-for-librarians">For Institutions & Librarians</a> <a href="/pages/advertisers">For Advertisers</a> <a href="/pages/subscription-agents">For Subscription Agents</a> <a href="https://careers.jamanetwork.com/" target="_blank">For Employers & Job Seekers</a> <a href="https://media.jamanetwork.com" rel="nofollow" target="_blank">For the Media</a> <a href="/pages/equity-diversity-inclusion">Equity, Diversity, Inclusion</a> <a href="/pages/commenting-policy">Online Commenting Policy</a> <a href="/pages/access-at-jama-network">Public Access and Open Access Policy</a> <a href="/pages/offensive-content-statement">Statement on Potentially Offensive Content</a> </div> <div class="services-links"> <h4 id="BodyContent_Footer_JAMANetworkProductsHeader" class="footer-subheading">JAMA Network Products</h4> <a href="http://www.amamanualofstyle.com/" class="footer-service-link" target="_blank">AMA Manual of Style</a> <a href="https://jamaevidence.mhmedical.com/" class="footer-service-link" target="_blank"><span class="jn-registered">JAMAevidence</span></a> <a href="http://www.peerreviewcongress.org/" class="footer-service-link" target="_blank">Peer Review Congress</a> </div> <div class="learning-links"> <h4 id="BodyContent_Footer_LearningHeader" class="footer-subheading">JN Learning</h4> <a href="https://edhub.ama-assn.org/jn-learning">Home</a> <a href="https://edhub.ama-assn.org/jn-learning/state-cme">State CME</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/clinical-challenge-courses">Clinical Challenge CME</a> <a href="https://edhub.ama-assn.org/jn-learning/course/288 ">Atrial Fibrillation Course</a> <a href="https://edhub.ama-assn.org/jn-learning/course/294 ">Women's Health Course</a> <a target="_blank" href="https://edhub.ama-assn.org/pages/auto-credit-reporting">CME / MOC Reporting Preferences</a> <a href="https://edhub.ama-assn.org/jn-learning/pages/about-cme">About CME & MOC</a> </div> </div> </div> </div> <div id="footer-resources-wrap" class="footer-resources-wrap"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Right" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .footer-resources-wrap .footer-subheading {color: grey;display:block !important;font-size: 1.17647em;font-weight: 400;text-transform: uppercase;} </style> <div class="footer-heading-wrap"> <h3 class="footer-heading is-b footer-resources-heading" data-mobile-tog-target=".footer-resources">Help</h3> </div> <div class="footer-resources"> <a href="https://store.jamanetwork.com" class="footer-service-link" target="_blank">Subscriptions & Renewals</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-alerts" class="footer-service-link" rel="nofollow">Manage Emails</a> <a href="https://jamanetwork.com/oauthsignin?return_url=http%3A%2F%2Fjamanetwork.com%2Fmyaccount%23my-profile" class="footer-service-link" rel="nofollow">Update My Address</a> <a href="https://support.jamanetwork.com/hc/en-us" class="footer-service-link">Support Center</a> <a href="/myaccount " class="footer-service-link">My Account</a> <h4 class="footer-subheading jn-ss-subheading-mt">JAMA Career Center</h4> <a href="https://careers.jamanetwork.com/" class="footer-service-link" target="_blank">Physician Job Listings</a> </div> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Socials" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .widget-instance-AMA_Journal_Home_Socials .iconsocial {display: inline-block !important;width: 34px;height: 34px;min-width: unset !important;margin: 0 2px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 7px 7px;background-repeat: no-repeat;background-size: 18px;} .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:hover, .widget-instance-AMA_Journal_Home_Socials .iconsocial.instagram:focus {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png);border-color: #C13584;} .footer-resources-wrap .iconsocial {display: inline-block !important;width: 32px;height: 32px;min-width: unset !important;margin: 0 2px 0 3px !important;background-color: #fff;border-radius: 20px;border: 1px solid #191919;vertical-align: middle;} .footer-resources-wrap .iconsocial.instagram {background-image: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-black.svg);background-position: 6px 6px;background-repeat: no-repeat;background-size: 18px;} .footer-resources-wrap .iconsocial.instagram:hover, .footer-resources-wrap .iconsocial.instagram:focus {background-color: #C13584;border-color: #191919;} #load-instagram-image { background: url(https://cdn.jamanetwork.com/ImageLibrary/JamaNetwork/social/instagram-icon-fill.png) no-repeat -9999px -9999px; } </style> <div id="BodyContent_Footer_divSocial" class="social-links footer-social-links"> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.facebook.com/JAMAJournal/" class="social-link is-b facebook"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://twitter.com/JAMA_current" class="social-link is-b twitter"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.instagram.com/jamanetwork/?hl=en" class="iconsocial instagram"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.linkedin.com/company/jamanetwork/" class="social-link is-b linked-in"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.youtube.com/jamanetwork" class="social-link is-b you-tube"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://www.pinterest.com/jamanetwork/" class="social-link is-b pinterest"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="/rss/site_3/67.xml" class="social-link is-b rss"></a> <a target="_blank" rel="nofollow" data-emailid="6d35777a-fc12-4d2d-9b49-81d031835d91" href="https://jamanetwork.com/journals/jama/pages/jama-editors-summary" class="social-link is-b podcast"></a> <div id="load-instagram-image"> </div> </div> <div id="BodyContent_Footer_divEmailUpdate" class="footer-email-updates"> <div class="widget-EmailListSignUp widget-instance-AMAv2_EmailListSignUp_Footer"> <div class="email-signup"> <div class="email-signup--text sb-pc">Get the latest from JAMA</div> <div class="email-signup--input-wrap is-b"> <input type="text" name="email" class="email-signup--input" placeholder="Email address" title="Email address" /> <a rel="nofollow" href="javascript:;" class="email-signup--submit sb-sc btn">Sign Up</a> </div> <div class="email-signup--link"> <a class="email-signup--privacy" href="/pages/privacy-policy">Privacy Policy</a> | <a class="email-signup--terms" href="/pages/terms-of-use">Terms of Use</a></div> <div class="email-signup--user-message"></div> </div> </div> </div> </div> <div class="footer-bar" itemscope itemtype="https://schema.org/Organization"> <input type="hidden" class="SelfServeContentId" value="v2_Footer_Bottom_Bar" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <style type="text/css"> .network-bar .auth--inst {color:#B8B8B8;} .multimedia-caption-container div.video-caption {color: #262626;font-size: 15px;font-weight: 700;line-height: 1.5;} .nav-journals a.theme-jama-health-forum:before {background: #133763;} .jn-bottom-bar {color: #fff; float: left;font-size: 10px;padding: 13px 20px;width: 33.33%;} .jn-bottom-bar p {line-height: 2;} @media (max-width: 900px) {.jn-bottom-bar {float: none;width: 100%;}} .jn-footer-copyright {font-size:12px;line-height:1.5;margin-bottom:10px;} .jn-footer-pipe {margin:0 10px;} .footer-bar-jn-logo img {width: 230px;} @media (max-width: 900px) {.footer-bar-jn-logo img {width: 200px;}} [data-thm=umb] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jama] .jobs-ad--text h6 {color: #d71635 !important;} [data-thm=jaman] .jobs-ad--text h6 {color: #ed0973 !important;} [data-thm=cardi] .jobs-ad--text h6 {color: #be1e32 !important;} [data-thm=derm] .jobs-ad--text h6 {color: #006f3b !important;} [data-thm=faci] .jobs-ad--text h6 {color: #ed1c24 !important;} [data-thm=jama-] .jobs-ad--text h6 {color: #fb5252 !important;} [data-thm=intem] .jobs-ad--text h6 {color: #006e96 !important;} [data-thm=neur] .jobs-ad--text h6 {color: #981b1e !important;} [data-thm=oncol] .jobs-ad--text h6 {color: #3b923f !important;} [data-thm=ophth] .jobs-ad--text h6 {color: #66bc29 !important;} [data-thm=otol] .jobs-ad--text h6 {color: #34b6e4 !important;} [data-thm=peds] .jobs-ad--text h6 {color: #0084c0 !important;} [data-thm=psych] .jobs-ad--text h6 {color: #005276 !important;} [data-thm=surg] .jobs-ad--text h6 {color: #f47920 !important;} .blockquote .para {margin: 0 0 1em 1em;} .jn-footer-copyright {display: block;} .inline-block {display: inline-block;} </style> <a class="footer-bar-jn-logo d-b no-mw mb1" href="/" title="JAMA Network Home"><img class="mw-100" src="https://cdn.jamanetwork.com/ImageLibrary/global/jn-signature-reversed-r.svg?versionId=82308" alt="Jama Network Logo"></a> <div class="jn-bottom-bar"> <p> <span class="jn-footer-copyright">© 2024 American Medical Association. <span class="inline-block">All rights reserved,</span> including those for text and data mining, AI training, <span class="inline-block">and similar technologies.</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/terms-use" rel="nofollow" class="p0">Terms of Use</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/privacy-policy" rel="nofollow" class="p0">Privacy Policy</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a href="https://www.ama-assn.org/about/accessibility-statement" rel="nofollow" class="p0">Accessibility Statement</a><span class="jn-footer-pipe">|</span></span> <span class="inline-block"><a onclick="OneTrust.ToggleInfoDisplay()" rel="nofollow" class="p0" id="CookieFooter">Cookie Settings</a></span> </p> </div>  <a class="footer-bar-sis no-mw relative nudge-down" href="https://www.silverchair.com" target="_blank"><img class="footer-bar-sis-img mt05 mw-100" width="600" height="70" src="//cdn.jamanetwork.com/UI/app/img/powered.png" alt="Silverchair Logo" /></a> </div> </footer> </div> <div class="ss-ui-only"> <div class="widget-SelfServeContent widget-instance-AMA_SS_UI_Only"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SsUiOnly" /> <input type="hidden" class="SelfServeVersionId" value="0" /> . </div> </div> </div> </section> <div id="revealModal" class="reveal-modal" data-reveal> <div id="revealContent"></div> <a class="close-reveal-modal icon-close"></a> </div> <div class="artmet-modal" id="MetricsModal"> <div class="artmet-modal-contents"> <a class="artmet-close-modal">×</a> </div> </div> <div class="widget-SigninModals widget-instance-AMA_SigninModals"> <div class="js-modal-no-access-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_NoAccess_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_NoAccess_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div>  </div> </div> <div class="widget-DeepDyve widget-instance-AMA_NoAccess_DeepDyve"> <button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jama.2009.1322&fieldName=journal_doi&affiliateId=JAMA" data-doi="10.1001/jama.2009.1322" data-fieldname="journal_doi" data-issneissn="0098-7484" data-affiliate="JAMA">Rent article</button> <div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-paid-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Access your subscriptions</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_PaidPdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_PaidPdf_SigninModal_PurchaseOptions_NoAccessAndPaidPDF"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_NoAccessAndPaidPDF" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr> <button class="modal--btn js-btn-subscribe-journal" type="button" role="button"> <div class="text-truncate">Subscribe to journal</div> </button> <div class="modal--btn-desc">Get full journal access for 1 year</div> <button class="modal--btn js-btn-purchase-article" type="button" role="button"> <div class="text-truncate">Buy article</div> </button> <div class="modal--btn-desc">Get unlimited access and a printable PDF ($40.00)—<br> <em>Sign in or create a free account</em></div>  </div> </div> <div class="widget-DeepDyve widget-instance-AMA_PaidPDF_DeepDyve"> <button type="button" role="button" class="modal--btn js-deepdyve-link hiddenRentalLink" data-deepdyveurl="https://www.deepdyve.com/doc-view?docId=10.1001/jama.2009.1322&fieldName=journal_doi&affiliateId=JAMA" data-doi="10.1001/jama.2009.1322" data-fieldname="journal_doi" data-issneissn="0098-7484" data-affiliate="JAMA">Rent article</button> <div class="modal--btn-desc js-deepdyve-desc hiddenRentalLink">Rent this article from DeepDyve</div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-free-pdf-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Sign in to access free PDF</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-AmaAdvancedSeamlessAccess widget-instance-AMA_FreePdf_AdvancedSeamlessAccessButton"> <div class="seamless-access-button--wrap"> <button class="d-flex sa-button align-items-center" role="button" type="button"> <div class="sa-button-logo-wrap"> <img src="//cdn.jamanetwork.com/UI/app/svg/seamless-access.svg" class="sa-button-logo" alt="Seamless Access Logo" /> </div> <div class="d-flex justify-content-center align-items-center sa-button-text text-truncate"> <div class="sa-button-text-primary text-truncate">Access through your institution</div> </div> </button> <div class="sa-access-text text-truncate hide"> <div class="sa-cta-access"><span>Add or change institution</span></div> </div> </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_FreePdf_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-save-search-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Save your search</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_SaveSearch_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_SaveSearch"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_SaveSearch" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Purchase access</div> <hr /> <button class="modal--btn js-btn-subscribe-now">Subscribe now</button>  </div> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-follow-collection-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Customize your interests</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_FollowCollection_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_FollowCollection"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_FollowCollection" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul>  </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="js-modal-user-comment-reveal no-access reveal-modal modal tiny" data-reveal> <div class="modal--box"> <div class="modal--title">Make a comment</div> <hr /> <button type="button" role="button" class="modal--btn js-btn-signin-personal" data-oauth-signin-url="https://jamanetwork.com/oauthsignin?return_url=https%3a%2f%2fjamanetwork.com%2fjournals%2fjama%2ffullarticle%2f184587"> Sign in<span class="fw-normal"> | personal account</span> </button> <div class="widget-SelfServeContent widget-instance-AMA_UserComment_SigninModal_CreateAccount"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_CreateAccount" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--title">Free access to newly published articles</div> <hr> <button class="modal--btn js-btn-create-personal-account" type="button" role="button"> <div class="text-truncate">Create a free personal account</div> </button> <div class="modal--btn-desc">To register for email alerts, access free PDF, and more</div>  </div> </div> <div class="widget-SelfServeContent widget-instance-AMA_SigninModal_PurchaseOptions_UserComment"> <div class="self-serve"> <input type="hidden" class="SelfServeContentId" value="SigninModal_PurchaseOptions_UserComment" /> <input type="hidden" class="SelfServeVersionId" value="0" /> <div class="modal--sub-title">Create a personal account or sign in to:</div> <ul> <li>Register for email alerts with links to free full-text articles</li> <li>Access PDFs of free articles</li> <li>Manage your interests</li> <li>Save searches and receive search alerts</li> <ul>  </div> </div> <div class="modal--link-wrap"> <a class="modal--link" href="/pages/privacy-policy" rel="nofollow">Privacy Policy</a> </div> </div> <a class="close-reveal-modal icon-close"></a> </div> <div class="hidden-true js-modal-page-data" data-store-url="https://store.jamanetwork.com" data-store-purchase-url="https://jamanetwork.com/oauthsignin?return_url=https://store.jamanetwork.com" data-store-subscribe-url="https://store.jamanetwork.com/index.aspx?productcode=64"> </div> </div> <script src="//cdn.jamanetwork.com/UI/app/vendor/jquery-2.2.4.min.js?v=638654734634555810"></script> <script>window.jQuery || document.write('<script src="/UI/app/vendor/jquery-2.2.4.min.js">\x3C/script>')</script> <script src="//cdn.jamanetwork.com/UI/app/dist/app.min.js?v=638677764559592887" defer></script> <script src="//cdn.jsdelivr.net/chartist.js/latest/chartist.min.js" type="text/javascript"></script> <script src="//d1bxh8uas1mnw7.cloudfront.net/assets/embed.js" type="text/javascript"></script> <script defer src='//js.trendmd.com/trendmd.min.js' data-trendmdconfig='{"element":"#trendmd-suggestions"}'></script> <script type='text/javascript' src='https://platform-api.sharethis.com/js/sharethis.js#property=643701de45aa460012e1032e&product=sop' async='async'></script> <script> var App = App || {}; App.showCmePromo = false; </script> </form> <link rel="stylesheet" href="//cdn.jamanetwork.com/UI/app/scss/modules/_trendMD.css"> <div class="widget-CustomJSScript widget-instance-"> <script src="//cdn.jamanetwork.com/ama/ama.proxylogging.js" async></script> </div> </body> </html>