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Review Article

Acute Kidney Injury and Chronic Kidney Disease as Interconnected Syndromes

List of authors.
  • Lakhmir S. Chawla, M.D.,
  • Paul W. Eggers, Ph.D.,
  • Robert A. Star, M.D.,
  • and Paul L. Kimmel, M.D.

This review considers evidence that acute and chronic kidney diseases are not distinct entities but rather are closely interconnected. The implications of this insight are discussed in terms of the approach to patients with kidney disease.

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Funding and Disclosures

The views expressed in this article do not necessarily reflect those of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institutes of Health, the Department of Health and Human Services, or the U.S. government.

Dr. Chawla reports receiving fees for serving on steering committees from AbbVie and AM-Pharma, fees for serving as an adjudicator for a clinical end-point study from Alere, fees for device development from Covidien, Gambro, Bard Medical, and NxStage Medical, fees for serving as a principal investigator for trials sponsored by Astute Medical, fees for clinical-trial development and planning from Ikaria, and grant support from Eli Lilly. He also reports providing expert testimony in a case of a patient with severe rhabdomyolysis and in a case of a patient who died after intubation. No other potential conflict of interest relevant to this article was reported.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

We thank Ms. Roberta Albert of the NIDDK for assistance in the preparation of the original drafts of the figures and several colleagues for providing critical reviews of an earlier version of the manuscript.

Author Affiliations

From the Department of Medicine, Division of Intensive Care Medicine, and the Division of Nephrology, Washington, DC, Veterans Affairs Medical Center (L.S.C.), and the Department of Anesthesiology and Critical Care Medicine (L.S.C.) and Department of Medicine, Division of Renal Diseases and Hypertension (L.S.C., P.L.K.), George Washington University Medical Center — both in Washington, DC; and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD (P.W.E., R.A.S., P.L.K.).

Address reprint requests to Dr. Kimmel at the NIDDK, NIH, 6707 Democracy Blvd., Bethesda, MD 20892, or at .

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