Abstract: SA-PO015

Risk Factors for Community-Acquired AKI in Patients with and without CKD and Impact of Its Initial Management on Prognosis: A Prospective Observational Study

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Saudan, Patrick, Geneva University Hospitals, Geneva, Switzerland
  • Stucker, Fabien, Hôpital de la Providence, Neuchatel, Switzerland
  • Perneger, Thomas, Geneva University Hospitals, Geneva, Switzerland
  • Alves, Cyrielle, Geneva University Hospitals, Geneva, Switzerland
  • Martin, Pierre-Yves F., Geneva University Hospitals, Geneva, Switzerland
Background

We aimed to describe clinical characteristics of patients with community-acquired acute kidney injury (CA-AKI), the effectiveness of initial management of CA-AKI, its prognosis and the impact of medication on its occurrence in patients with previous chronic kidney disease (CKD).

Methods

We conducted a prospective observational study within the Emergency Department (ED) of a University Hospital including any patient > 16 years admitted with an eGFR < 60 ml/mn/1.73m2. With the help of a computer-based database, we identified daily the patients admitted with an eGFR < 60ml/mn/1.73m2 and a panel of nephrologists reviewed the files to assess the presence of AKI. We then analysed the clinical and demographic characteristics of the patients, the use of medications, and the adequate management of CA-AKI within the ED.The files were reviewed in the subsequent days and at one and three-years and mortality, renal recovery and renal function decline were analyzed.

Results

From May 1st to June 21st 2013, there were 8464 admissions in the ED, of which 653 had an eGFR < 60 ml/mn/1.73m2. Of these, 352 had previous CKD, 341 had CA-AKI, and 104 had superimposed CA-AKI on CKD.
Occurrence of superimposed CA-AKI in CKD patients was associated with male gender and with use of diuretics, but not with use of ARBs or ACEIs.
Adequate management of CA-AKI defined as identification, diagnostic procedures and therapeutic intervention within 24 hours, was recorded in 45% of the cases and was not associated with improved outcomes.
Three-year mortality was 21 and 48 % in CKD patients, respectively, without or with CA-AKI, and 40 % in patients with only CA-AKI (p<0.001). Mortality was significantly associated with age, hypertension, ischemic heart disease and CA-AKI.
Progression of renal insufficiency was associated with male gender and age.

Conclusion

CA-AKI is more frequently encountered in male patients and those treated with diuretics and is an independent risk factor for long-term mortality. Its initial adequate management failed to improve outcomes.