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Kidney Week

Abstract: TH-PO019

Risk Factors for Community-Acquired Kidney Disease

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Macedo, Etienne, University of California San Diego Medical Center, La Jolla, California, United States
  • Hemmila, Ulla, College of Medicine, Malawi, Kokemäki, Finland
  • Sharma, Sanjib Kumar, B P Koirala Institute of Health Sciences, Dharan, Nepal
  • Claure-Del Granado, Rolando, Hospital Obrero#2-Universidad Mayor de San Simon, Zona Sarco, Bolivia, Plurinational State of
  • Mzinganjira, Henry E., MOH , Blantyre, Malawi
  • Bartaula, Bijay, B P Koirala Institute of Health Sciences, Dharan, Nepal
  • Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Cerda, Jorge, Capital District Renal Physicians, Albany, New York, United States
  • Mehta, Ravindra L., University of California San Diego Medical Center, La Jolla, California, United States

Group or Team Name

  • ISN 0by25
Background

Risk factors for the development of AKI in the community, either presenting to Community Health Center (CHC) or emergency departments (ED), have not been well studied in Low and Lower-Middle Income Countries (LLMIC). A key limitation is the heterogeneity of diseases and a lack of a standardized approach to evaluating renal dysfunction. We evaluated the risk factors associated with acute kidney disease (AKD) within the International Society of Nephrology 0by25 Pilot Feasibility Project, designed to improve detection and management of community acquired-AKI in LLMIC.

Methods

Patients (pts) presenting to CHC or ED were screened for signs or symptoms a priori associated with risk of developing AKI. Pts with high/moderate risk underwent a serum creatinine (sCr) POC test and a urine dipstick. Pts were classified as chronic kidney disease (CKD) based on prior history, proteinuria (>1+) and/or baseline sCr within 12 mos by estimated GFR (CKD-EPI equation)) <60 mL/min/1.73 m2; normal renal function (NRF) (negative proteinuria and eGFR>75ml/min/1.73 m2); Acute Kidney Disease (AKD) neither meeting criteria for CKD or NRF. AKI was confirmed within 7 days by sCr increase or decrease of 0.3mg/dl, or 1.5x from the reference value.

Results

3,577 pts were screened; 319 CKD and 379 children <12 years old were excluded from this analysis. Of 2,879 remaining pts, 1248 (43%) were classified as AKD at enrollment; 496 had NRF; and 1,135 with low risk for AKI, were assumed to have a normal renal function. Over the first 7 days, 438(3.5%) from AKD and 58(35%) from NRF group met criteria for AKI. In comparison to NRF, pts with AKD had a higher frequency of diabetes (13% AKD vs. 9%NRF), hypertension (22%AKD vs.16%NRF) and chronic liver disease (5%AKD vs. 2%NRF). Dehydration associated with vomiting and low oral intake was the most common risk factor for AKD, followed by diarrhea, hypotension and appetite loss. Pts with AKD were more often hospitalized and had high mortality rates; 9% at 7 days and 15% at 6months.

Conclusion

Comorbidities and a set of signs and symptoms can identify adult patients at risk for AKD and can be used to select patients that may benefit from POC testing in CHC. Crucially, identification of kidney dysfunction can help discriminate patients who may benefit from higher levels of care.

Funding

  • Private Foundation Support