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Kidney Week

Abstract: FR-PO088

Pre-Admission Proteinuria Increases Risk of Non-Recovery after Dialysis-Requiring AKI

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Lee, Benjamin J., UCSF, San Francisco, California, United States
  • Go, Alan S., KPNC, Oakland, California, United States
  • Parikh, Rishi V, KPNC, Oakland, California, United States
  • Leong, Thomas, KPNC, Oakland, California, United States
  • Tan, Thida C., KPNC, Oakland, California, United States
  • Walia, Sophia, KPNC, Oakland, California, United States
  • Hsu, Raymond K., UCSF, San Francisco, California, United States
  • Liu, Kathleen D., UCSF, San Francisco, California, United States
  • Hsu, Chi-yuan, UCSF, San Francisco, California, United States
Background

Renal recovery after dialysis-requiring acute kidney injury (AKI-D) is an important clinical and patient-centered outcome. We examined whether pre-AKI-D proteinuria level is an independent risk factor for non-recovery within a diverse, community-based population.

Methods

We evaluated all adult members of Kaiser Permanente Northern California who experienced an episode of AKI-D between 1/1/2009 and 9/30/2015. Pre-admission dipstick proteinuria level was identified ≤4 years before hospitalization. Renal recovery was defined as alive and dialysis-independent ≥4 weeks at 90 days after starting renal replacement therapy. Baseline estimated glomerular filtration rate (eGFR), age, gender, race, short-term predicted risk of death, relevant comorbidities, and medication use were identified from electronic health records.

Results

Among 5,347 adults with AKI-D, mean age was 66 years, 59% were men, and 50% were white. In multivariable logistic regression, compared with negative/trace proteinuria, adjusted odds ratios for non-recovery were 1.47 (95%CI 1.19-1.82) for 1+ proteinuria and 1.92 (1.54-2.38) for ≥2+ proteinuria. Among survivors, crude probability of recovery ranged from 83% for negative/trace proteinuria with baseline eGFR >60 mL/min/1.73m2 to 25% for ≥2+ proteinuria with eGFR 15-29 mL/min/1.73m2 (Figure).

Conclusion

Dipstick proteinuria was a graded, independent risk factor for non-recovery after AKI-D and contributes to short-term risk stratification and prognostication in combination with baseline eGFR. Pre-AKI-D proteinuria information is important for appropriately counseling patients and planning follow-up care.

Funding

  • NIDDK Support