Abstract: FR-PO128

Non-Recovery After Dialysis-Requiring AKI Is Associated with Increased Short-Term Mortality and Cardiovascular Events in Incident ESRD Patients

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

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

There is a high burden of early mortality and cardiovascular disease (CVD) in ESRD patients. We hypothesized that patients with ESRD precipitated by non-recovery after dialysis-requiring acute kidney injury (AKI-D) are at higher risk for short-term death and CVD events compared to incident ESRD patients who did not experience AKI-D.

Methods

We evaluated adult members of Kaiser Permanente Northern California who initiated renal replacement therapy between January 2009 and September 2015. Outcomes were all-cause death, heart failure hospitalization, acute coronary syndrome (ACS), and acute ischemic stroke or transient ischemic attack (TIA) within 1 year of dialysis initiation. Baseline demographics, eGFR, dipstick proteinuria, other labs, comorbidities, and medication use were identified from electronic health records and used for multivariable adjustment.

Results

Patients with ESRD due to AKI-D (n=1,865) were older, more likely to be white, and had more baseline CVD than incident ESRD patients without AKI-D (n=3,772). Preceding AKI-D was associated with higher crude risks of death and CVD events (Table). In multivariable Cox regression, patients with ESRD due to AKI-D were at statistically significantly higher risk for death (adjusted hazard ratio [aHR] 1.79, 95% CI 1.49-2.13) and heart failure hospitalization (aHR 2.22, 1.43-3.33). Trends for ACS (aHR 1.25, 0.88-1.75) and acute ischemic stroke/TIA (aHR 1.27, 0.85-1.89) were not statistically significant.

Conclusion

Patients who transition to ESRD via AKI-D are a high-risk subgroup that may benefit from aggressive monitoring and medical management, particularly for heart failure.

Crude rates of death and CVD outcomes at 1 year after dialysis initiation, stratified by whether ESRD was precipitated by AKI-D.
OutcomeSubgroupRate per 100 person-years (95% Confidence Interval)P-value
All-Cause DeathESRD not due to AKI-D9.51 (8.50-10.65)<0.0001
ESRD due to AKI-D23.58 (18.06-30.78)
Heart Failure HospitalizationESRD not due to AKI-D3.00 (2.45-3.67)<0.0001
ESRD due to AKI-D8.17 (5.09-13.11)
Acute Coronary SyndromeESRD not due to AKI-D3.45 (2.86-4.17)0.0081
ESRD due to AKI-D5.14 (3.17-8.33)
Acute Ischemic Stroke or TIAESRD not due to AKI-D2.68 (2.16-3.32)0.1168
ESRD due to AKI-D3.53 (2.02-6.18)

Funding

  • NIDDK Support