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Abstract: FR-PO098

Impact of AKI and Source of Serum Creatinine Measurements on Subsequent Kidney Function Decline

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Hsu, Raymond K., University of California San Francisco, San Francisco, California, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Yang, Jingrong, Kaiser Permanente Northern California, Oakland, California, United States
  • Anderson, Amanda Hyre, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • He, Jiang, Tulane School of Medicine, New Orleans, Louisiana, United States
  • Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Porter, Anna C., University of Illinois, Chicago, Chicago, Illinois, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
  • Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States
  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
  • Xie, Dawei, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Zhang, Xiaoming, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
Background

Acute kidney injury (AKI) is linked to chronic kidney disease (CKD) progression, but this epidemiological association may be susceptible to ascertainment bias in studies using clinical data, as patients may be more likely to undergo kidney function testing post-AKI.

Methods

We evaluated whether impact of AKI on kidney function trajectory varied using clinical vs. research protocol-driven data in 444 adult CKD participants of the Chronic Renal Insufficiency Cohort (CRIC) Study who were also members of a large integrated healthcare system. We estimated separate eGFR trajectories using (1) serum creatinine (SCr) measurements performed annually through CRIC research protocol, or (2) SCr measurements performed in clinical care. We used linear mixed models to test the associations of AKI with absolute change in eGFR and post-AKI eGFR slope and whether these associations varied by source of serum creatinine (clinical vs. research), adjusting for demographics, baseline albuminuria and diabetes.

Results

During mean follow-up of 7.5 years, mean rate of eGFR loss was 0.31 ml/min/1.73m2 per year overall (in the referent group with mean age of 60, male, non-black, and without albuminuria or diabetes); 74 individuals experienced AKI (54% Stage 1). An AKI episode was not significantly associated with an acute change in absolute eGFR level after discharge, but was significantly associated with a faster rate of eGFR decline (mean additional loss of 0.67 ml/min/1.73m2 per year, P<0.0001). However, the latter association was attenuated and no longer significant when using only research measurements (Table1).

Conclusion

The impact of AKI on subsequent rate of kidney function loss is influenced by source of SCr, and may be modest after accounting for other risk factors.

Table1: Multivariable mixed effects model showing association of AKI and kidney function trajectory
PredictorsCoefficientP
Impact of AKI episode on acute change in level of eGFR (overall)2.010.59
Impact of AKI episode on acute change in level of eGFR (using research SCr only)-0.350.69
Impact of AKI episode on subsequent rate of eGFR decline (overall)-0.67<0.0001
Impact of AKI episode on subsequent rate of eGFR decline (using research SCr only)-0.0290.9

Funding

  • NIDDK Support