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Kidney Week

Abstract: FR-PO028

Post-AKI eGFR and ACR and Future Risk of Kidney Disease Progression

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Wurfel, Mark M., University of Washington, Seattle, Washington, United States
  • Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States
Background

Some have advocated routine post-dischage nephrology follow-up for hospitalized patients who experienced AKI. We hypothesize that post-hospitalization eGFR and proteinuria levels risk stratify patients bettter than presence or severity of AKI.

Methods

We studied 1603 adult ASSESS-AKI study participants (PMID: 20799966). ASSESS-AKI prospectively enrolled hospitalized patients with and without AKI in a parallel, matched cohort. All participants had an outpatient baseline research study visit 3 months post-discharge when eGFR, ACR and comorbitidies were ascertained. Cox models were used to examine predictors of kidney disease progression, defined as time to halving of eGFR or ESRD.

Results

Median age of the study population was 66 (IQR 56-74) yrs; eGFR 69 (51-90) ml/min/1.73m2, ACR 14 (7-56) mg/g. 38% were female, 13% black, 3% Hispanic, and 41% had diabetes mellitus (DM). 772 participants had AKI and 831 did not. Most cases of AKI were mild to moderate in severity (72% stage 1, 15% stage 2). 139 participants had kidney disease progression after a median follow-up of 4.8 yrs. Severity of AKI was associated with kidney disease progression in simple and multivariable Cox models (Table). However, taking into account AKI severity did not materially improve risk stratification beyond a Cox model which contained basic demographics, DM status, SBP, BMI, eGFR and ACR (C-statistic 0.83 vs. 0.82). A Cox model with post-AKI ACR alone had a C-statistic of 0.81. (Similar results were seen when AKI was captured as presence or absence rather than staged by severity.)

Conclusion

Post-hospitalization levels of eGFR and ACR should guide triaging for implementation or intensification of reno-protective measures more so than presence or severity of AKI during hospitaliation. Patients who have preserved eGFR and low ACR after hospitalization have good renal prognosis and may not need referral to nephrology, regardless of whether AKI occured or not.

 UnadjustedUnadjustedUnadjustedAdjusted*Adjusted*
AKI stage 13.08 (2.08-4.55)   1.70 (1.12-2.58)
AKI stage 22.89 (1.51-5.22)   1.66 (0.85- 3.26)
AKI stage 35.02 (2.84-8.90)   3.02 (1.66- 5.47)
eGFR (per 10 ml/min/1.73m2) 1.53 (1.41-1.66) 1.31 (1.21- 1.42)1.28 (1.18- 1.39)
ACR (mg/gm)(per doubling)  1.54 (1.45-1.62)1.32 (1.23- 1.42)1.33 (1.24- 1.42)
 C statistic 0.49C statistic 0.76C statistic 0.81C statistic 0.82C statistic 0.83

*adjusted for center, demographics, SBP, BMI

Funding

  • NIDDK Support