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Abstract: FR-PO377

AKI Followed by Complete Recovery Is Associated with Higher Stroke Risk

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Teixeira, Joao Pedro, University of Colorado, Aurora, Colorado, United States
  • You, Zhiying, UC Denver, Aurora, Colorado, United States
  • Griffin, Benjamin, University of Colorado, Aurora, Colorado, United States
  • Holmen, John R., Intermountain Healthcare, Murray, Utah, United States
  • Srinivas, Titte, Intermountain Medical Center, Murray, Utah, United States
  • Chonchol, Michel, University of Colorado, Aurora, Colorado, United States
  • Faubel, Sarah, University of Colorado Denver , Denver, Colorado, United States
  • Jovanovich, Anna Jeanette, Denver VA , Denver, Colorado, United States
Background

Acute kidney injury (AKI) has been shown to be associated with a future increased risk of adverse cardiovascular events. However, there are fewer data specifically analyzing the risk of stroke after AKI and they have been somewhat mixed. While severe (stage III) AKI has been shown to be independently associated with an increased risk of future stroke, the effects of less severe AKI or AKI with recovery are unclear. We aim to determine the risk of stroke following an admission complicated by AKI with complete recovery in a propensity score-matched cohort of cases and controls.

Methods

We identified 1139 AKI cases (AKI Network definition) with complete kidney function recovery at the time of discharge, defined as serum creatinine <1.10 times the pre-admit baseline value, during a hospitalization between January 1, 1999 and December 31, 2009 from an integrated health care delivery system. We matched 1139 controls (no AKI during index admit) based on a propensity score including age, sex, race, prior inpatient visits, season of admission, baseline creatinine, and all components of the Charlson Comorbidity index. The primary outcome was time to post-discharge stroke, as defined by ICD-9 codes. Cox proportional hazards models were adjusted for history of prior stroke and atrial fibrillation and censored for death.

Results

Baseline characteristics among the cases and controls were similar: age 62 ± 17 years, 46% female, 92% white, serum creatinine 0.9 ± 0.2 mg/dL. During a median [IQR] post-discharge follow-up of 68 [17-92] months, 99 cases and 36 controls had a stroke. In the unadjusted model, AKI with recovery was associated with a greater than 3-fold increased risk of stroke (HR 3.08 [95% CI, 2.10 – 4.52]; p <0.0001). This association did not change after adjusting for prior stroke and atrial fibrillation (HR 3.27 [95% CI, 2.21 – 4.2]; p <0.0001).

Conclusion

Among patients from an integrated health care delivery system, AKI followed by complete recovery was independently associated with an increased risk of incident stroke. These data add to prior studies linking AKI with an increased long-term risk of cardiovascular events.

Funding

  • Veterans Affairs Support