Abstract: SA-PO008
Renal Recovery after Dialysis-Requiring AKI Is Associated with Decreased Short-Term Mortality
Session Information
- AKI Clinical: Epidemiology and Outcomes
November 04, 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., 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
Dialysis-requiring acute kidney injury (AKI-D) is associated with increased risk of death even after hospital discharge and higher subsequent rates of cardiovascular disease. We examined whether renal recovery after AKI-D mitigates these risks in a diverse, community-based cohort.
Methods
We evaluated all adult members of Kaiser Permanente Northern California who experienced AKI-D between January 2009 and September 2015. We compared AKI-D patients who recovered adequate kidney function to come off dialysis to AKI-D patients who did not. The primary 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 acute renal replacement therapy initiation. Baseline demographics, eGFR, dipstick proteinuria, other labs, comorbidities, and medication use were identified from electronic health records and used for multivariable adjustment.
Results
Compared to AKI-D patients who did not recover (n=1,865), AKI-D patients who recovered (n=1,347) were younger, had higher baseline eGFR and less proteinuria, and were less likely to have pre-existing cardiovascular disease, hypertension, or diabetes. In multivariable Cox regression, recovery after AKI-D was independently associated with a 30% lower relative risk of all-cause death (adjusted hazard ratio [aHR] 0.70, 95% CI 0.55-0.88). Recovery after AKI-D was not statistically significantly associated with adjusted differences in heart failure hospitalization, ACS, or acute ischemic stroke/TIA events (Table).
Conclusion
Recovery after AKI-D was independently associated with lower short-term mortality. Interventions to promote early recovery of renal function after AKI-D should be evaluated.
Multivariable-adjusted associations for death and cardiovascular outcomes at 1 year after initiation of renal replacement therapy, by recovery status after AKI-D.
| Outcome | Subgroup | Adjusted Hazard Ratio (95% Confidence Interval) |
| All-Cause Death | Not Recovered | Reference |
| Recovered | 0.70 (0.55-0.88) | |
| Heart Failure Hospitalization | Not Recovered | Reference |
| Recovered | 1.38 (0.88-2.17) | |
| Acute Coronary Syndrome | Not Recovered | Reference |
| Recovered | 0.97 (0.56-1.69) | |
| Acute Ischemic Stroke or TIA | Not Recovered | Reference |
| Recovered | 0.52 (0.26-1.05) |
Funding
- NIDDK Support