Abstract: TH-PO007
Predictive Factors of Renal Recovery Following AKI
Session Information
- AKI: Epidemiology, Risk Factors, Prevention
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Bouchard, Josee, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- Ostermann, Maria, Guy's & St Thomas' Hospital , London, United Kingdom
- Tolwani, Ashita J., University of Alabama at Birmingham, Birmingham, Alabama, United States
- Passos, Rogerio, Hospital Sao Rafael, Salvadir, Brazil
- Lewington, Andrew J.P., Leeds Teaching Hospitals, Leeds, United Kingdom
- Mccullagh, Iain, Newcastle Hospitals NHS Trust, Newcastle upon tyne, United Kingdom
- Doi, Kent, University of Tokyo, Tokyo, Japan
- Liang, Xinling, Guangdong general hospital, Guangzhou, China
- Maccariello, Elizabeth R., Hospital Quinta D'Or, Rio de Janeiro, Brazil
- Claure-Del Granado, Rolando, Unaer Srl, Zona Sarco, Bolivia, Plurinational State of
- Thompson, Christopher J., Royal Stoke University Hospital , Stoke on Trent, United Kingdom
- Fiaccadori, Enrico, Universita Degli Studi-Dip. Clinica Medica Nefrologia, Parma, Italy
- Chee, Nigel M., Royal Bournemouth Hospital, Bournemouth, United Kingdom
- Raithatha, Ajay H., Sheffield Teaching Hospitals NHS Foundation Trust, UK, Sheffield, United Kingdom
- Acharya, Anjali, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
- Cerda, Jorge, Capital District Renal Physicians, Albany, New York, United States
- Madarasu, Rajasekara Chakravarthi, STAR Kidney Center, STAR Hospitals, Hyderabad, India
- Macedo, Etienne, University of California San Diego, San Diego, California, United States
- Mehta, Ravindra L., University of California San Diego Medical Center, La Jolla, California, United States
Background
AKI is frequent and predictors of renal recovery are incompletely understood. We aimed to determine the association between clinical characteristics and risk factors for AKI with renal recovery.
Methods
This prospective observational study was conducted among intensive care unit patients from 25 centers in 9 countries. AKI was defined as an increase in creatinine of at least 0.3 mg/dl within 48 hours, and renal recovery, as a creatinine at hospital discharge within less than 0.5 mg/dl of reference creatinine.
Results
Between 2008 and 2018, 14,460 patients were screened, of whom 4,241 (29%) developed AKI. A total of 2,009 (47%) of AKI patients had sufficient data. Median age was 64 years (IQR 50-74), 63% were male, 67% were Caucasian, 19% Asian and 7% were Black. Thirty-two percent came from emerging countries and 44% had CKD. Thirty-six percent underwent surgery, 47% had sepsis, and 47% received vasopressors. APACHE III scores at ICU admission was 61 (IQR 43-83). Within the first 7 days of AKI, 43% had hypotension, 14% received iodinated contrast, 26% required anesthesia and 72% received nephrotoxins (including any antibiotics). In-hospital mortality was 20%, and 19% received dialysis during hospital stay. Seven percent of 1613 survivors were dialysis-dependent at discharge, while 72% recovered their renal function. A lower probability of renal recovery was associated with older age, residence in an emerging country, presence of diabetes and liver disease, medical reason for ICU admission and provision of dialysis, while administration of vasopressors was associated with a better probability of renal recovery. Additional risk factors for AKI were not associated with a lower probability of renal recovery.
Conclusion
In our study, older age, residence in an emerging country, diagnosis of diabetes and liver disease, medical reason for ICU admission, as well as severe AKI were independently associated with a lower renal function at hospital discharge. However, ongoing risk factors for AKI within days of diagnosis did not modify renal prognosis at discharge.
Funding
- NIDDK Support