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Abstract: TH-OR113

Multiple Episodes of AKI and Their Association with Kidney Function and Death

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States
  • Liu, Kathleen D., University of California at San Francisco School of Medicine, San Francisco, California, United States
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Wurfel, Mark M., University of Washington, Seattle, Washington, 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
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States

Group or Team Name

  • on behalf of the ASSESS-AKI Investigators

Recurrent AKI may mediate the risk for future CKD outcomes. Prior studies on recurrent AKI lacked appropriate controls. We compared the incidence of future AKI between hospitalized AKI and nonAKI patients and the impact of AKI on kidney disease progression.


ASSESS-AKI is a prospective multi-center study of matched AKI and non-AKI patients followed longitudinally beginning 3 months after initial hospitalization. AKI was defined as a 0.3 mg/dl or 50% increase in baseline serum creatinine during subsequent hospitalizations. The determinants of future AKI were examined using multivariate Cox regression. Outcomes included time to event for (1) a composite renal outcome of incident or progressive CKD or ESRD, and (2) the competing risk of death. Predictors of outcome were examined using a multivariable trivariate Weibull regression model, along with a zero-inflated Poisson regression model for the number of AKI events prior to the composite renal endpoint.


Among 769 matched pairs of AKI and non-AKI patients, 465(30%) experienced a future AKI episode over a median follow-up of 57 months. Future AKI was more common among patients with AKI compared to nonAKI status at index hospitalizations, with 8 compared to 5 AKI episodes per 100 person-years (PYs)(p < 0.0001). After multivariate adjustment, index AKI remained independently associated with the risk for future AKI [aHR 1.5 (95%CI:1.2-1.8)]. The rates of the composite renal outcome were 2, 5, and 6 per 100 PYs among patients with 0, 1, and ≥2 episodes of AKI (p < 0.0001). The rates for death prior to a CKD event were 2, 4, and 9 among patients with 0, 1, and ≥2 episodes of AKI (p < 0.0001). After multivariable adjustment, the presence of 1 and ≥2 episodes of AKI conferred an increased risk for the CKD outcome [aHR 3.3(2.2-4.9) and 2.8(1.8-4.2)], respectively, compared to patients without AKI. There were incremental increases in the risk of death prior to a CKD event with 1[aHR 1.7(1.2-2.6)] and ≥2[aHR 2.8(1.8-4.2)] episodes of AKI compared to no AKI.


AKI is an independent risk factor for future hospitalized AKI and loss of kidney function. The association between multiple AKI events and future CKD outcomes may be affected by the competing risk of death.


  • NIDDK Support