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Kidney Week

Abstract: FR-PO037

AKI in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Necessitating Hospitalization

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Chen, Dawei, Nanjing First Hospital, Nanjing, China
  • Wan, Xin, Nanjing First Hospital, Nanjing, China
Background

Acute kidney injury (AKI) on patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remained unknown, and little is known about the differences between community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) in patients with AECOPD. Thus, we compared prevalence, risk factors, and outcomes for these patients with CA-AKI and HA-AKI.

Methods

Between January 2014 and January 2017, data from adult inpatients with AECOPD were analyzed retrospectively. In all, 1768 patients were included.

Results

Prevalence of CA-AKI was 15.8% and that of HA-AKI was 5.5%, giving an overall AKI prevalence of 21.3%. Comparing with patients without AKI, patients with AKI were more likely to require mechanical ventilation (38.7% versus 19.1%; P < 0.001), non-invasive mechanical ventilation (20.4% versus 16.0%; P = 0.044), invasive mechanical ventilation (18.3% versus 3.1%; P < 0.001), and intensive care unit (ICU) admission (33.7% versus 12.9%; P < 0.001). Patients with AKI had a longer duration of ICU stay (9 days versus 8 days; P = 0.033), a longer hospitalization (13 days versus 10 days; P < 0.001), and a higher inpatient mortality (18.0% versus 2.7%; P < 0.001). Patients with CA-AKI had a higher prevalence of chronic kidney disease (CKD) and lower prevalence of chronic cor pulmonale than patients with HA-AKI. Risk factors for developing HA-AKI and CA-AKI were similar: being elderly, requirement for mechanical ventilation and a history of coronary artery disease and CKD. Patients with HA-AKI were more likely to have stage-3 AKI and worse short-outcomes. In comparison with CA-AKI, patients with HA-AKI were more likely to require non-invasive mechanical ventilation (31.3% versus 16.8%; P = 0.003), and had a longer duration of mechanical ventilation (11 days versus 8 days; P = 0.020), longer hospitalization (14 days versus 12 days; P = 0.038), and higher inpatient mortality (32.0% versus 13.2%; P < 0.001). Those with HA-AKI had worse (multivariate-adjusted) inpatient survival than patients with CA-AKI (hazard ratio, 1.7 [95% CI, 1.03–2.81; P = 0.038] for the HA-AKI).

Conclusion

AKI was common in patients with AECOPD requiring hospitalization, and had a worse prognosis. CA-AKI was more common than HA-AKI but otherwise demonstrated similar demographics and risk factors. Nevertheless, patients with HA-AKI had worse short-term outcomes.