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Abstract: FR-PO039

Incidence and Outcomes of Acute-on-CKD - The French CKD-REIN Cohort Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Hamroun, Aghiles, CESP U1018, INSERM, Villejuif, France
  • Frimat, Luc, Nancy University Hospital, Vandoeuvre les Nancy, France
  • Laville, Maurice, Université de Lyon, Pierre-Bénite, France
  • Metzger, Marie, CESP U1018, INSERM, Villejuif, France
  • Lange, Celine, Biomedicine Agency, La Plaine Saint-Denis, France
  • Combe, Christian, CHU de Bordeaux, Bordeaux, France
  • Fouque, Denis, Université de Lyon, Pierre-Bénite, France
  • Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Massy, Ziad, Ambroise Pare University Hospital and Inserm U1018 Eq5, Boulogne Billancourt/ Paris cedex, France
  • Stengel, Benedicte, CESP U1018, INSERM, Villejuif, France
Background

Incidence and outcomes of de novo acute kidney injury (AKI) are well documented, but less is known about acute-on-chronic kidney disease (ACKD).

Methods

We estimated ACKD incidence rate over 1-year follow-up in 2375 patients with any type of CKD stages 3-4, but without past AKI at baseline. AKI events were defined and classified according to KDIGO 2012, and validated by an expert committee. Cause-specific Cox regression models identified factors associated with full renal recovery, defined by <10% increase in post AKI serum creatinine as compared with baseline creatinine, during the year post-AKI. We estimated cumulative incidences for the competing risks of end-stage kidney disease (ESKD) and death after ACKD. The hazard ratios [HR, 95% confidence intervals] of these outcomes associated with ACKD during the first year of follow-up were estimated by cause-specific Cox regression models, adjusted for sex, age, eGFR, and albuminuria.

Results

Overall, 142 patients (mean age 70 years, 69% men, mean eGFR 29mL/min/1.73m2, 50% with severely increased albuminuria -A3 range-) experienced a first AKI-event (25% outpatient) at a rate of 6 per 100 person-years: 73% were staged 1, 12% staged 2, and 13% staged 3. One hundred patients (70%) achieved full renal recovery, within a mean time of 4 months after AKI. Pre-renal AKI (HR=2.54 [1.42;4.54]), dehydration (HR=1.76 [1.00;3.17]) and drug-related AKI (HR= 2.04 [1.11;3,75]) were significantly associated with full renal recovery.
The cumulative incidences of ESKD and death after ACKD reached 13.1% and 15.7% at 12 months, respectively (Figure). ACKD was significantly associated with increased ESKD risk (adjusted HR=2.13 [1.32; 3.46]) and mortality (adjusted HR=2.07 [1.11; 3.83]).

Conclusion

ACKD is common and, despite a high rate of full renal recovery, it is associated with very high risks of both ESKD and death.

Post-ACKD outcomes.