Abstract: SA-OR109

AKI Precipitating Initiation of Chronic Maintenance Hemodialysis

Session Information

  • What Happens After AKI
    November 04, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 06:06 PM - 06:18 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Naseer, Adnan, VAMC, Germantown, Tennessee, United States
  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, KANAGAWA, Japan
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
  • Abbott, Kevin C., The National Institutes of Health, NIDDK, Bethesda, Maryland, United States
Background

Acute kidney injury (AKI) often occurs in patients with advanced chronic kidney disease (CKD) and may hasten the need to initiate maintenance hemodialysis (MHD) treatment. It is unclear how frequently AKI occurs in patients transitioning to MHD, and what outcomes it leads to.

Methods

We examined a national cohort of 23,349 US veterans initiating MHD during 2007-2014. We defined AKI as a 50% decrease in eGFR at the time of MHD start, compared to the expected eGFR estimated from the disease trajectory recorded in the last year before dialysis. Associations of AKI with all-cause mortality and with recovery of kidney function (per USRDS records) in the first 6 months after MHD start were examined in multivariable adjusted Cox models and competing risk regression models.

Results

Patients were 67±11 years old, 98% male, 33% African-American, and 72% diabetic. 4,804 (21%) of all patients had AKI. Renal recovery occurred in 12.2% of patients with AKI vs. 1.6% of those without AKI (adjusted subhazard ratio, 95%CI: 4.42, 3.72-5.27, p<0.001) (Fig A). AKI was associated with 45% higher multivariable adjusted mortality (hazard ratio and 95% CI: 1.45, 1.33-1.57) (Fig B).

Conclusion

Nearly 1 in 8 patients experienced AKI during transition to MHD, and this was associated with higher mortality in the immediate post-transition period. Patients with AKI also experience a much higher rate of renal recovery, hence careful attention to residual kidney function is warranted in these patients.

Funding

  • NIDDK Support