Abstract: SA-PO008

Renal Recovery after Dialysis-Requiring AKI Is Associated with Decreased Short-Term Mortality

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

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.
OutcomeSubgroupAdjusted Hazard Ratio (95% Confidence Interval)
All-Cause DeathNot RecoveredReference
Recovered0.70 (0.55-0.88)
Heart Failure HospitalizationNot RecoveredReference
Recovered1.38 (0.88-2.17)
Acute Coronary SyndromeNot RecoveredReference
Recovered0.97 (0.56-1.69)
Acute Ischemic Stroke or TIANot RecoveredReference
Recovered0.52 (0.26-1.05)

Funding

  • NIDDK Support