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Abstract: TH-PO006

Transition of Hospital-Associated AKI to Acute Kidney Disease and CKD

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Ho, Kevin, Geisinger, Danville, Pennsylvania, United States
  • Riviello, David, Geisinger, Danville, Pennsylvania, United States
  • Brown, Jason, Geisinger, Danville, Pennsylvania, United States
  • Saunders, Sara, Geisinger, Danville, Pennsylvania, United States
  • Bucaloiu, Ion D., Geisinger, Danville, Pennsylvania, United States
  • Singh, Gurmukteshwar, Geisinger, Danville, Pennsylvania, United States
  • Green, Jamie Alton, Geisinger, Danville, Pennsylvania, United States
  • Kirchner, H. Lester, Geisinger, Danville, Pennsylvania, United States

Acute kidney injury (AKI) is closely tied bidirectionally to the pathogenesis and public health burdens of chronic kidney disease (CKD) together with increased risks for hospital readmission, endstage kidney disease, and death. Bridging transient AKI and CKD, acute kidney disease (AKD) may represent a potentially modifiable stage in the natural history of kidney disease.


We performed a retrospective analysis of hospitalization data from the electronic health records for Geisinger, a large healthcare delivery system in Central Pennsylvania and New Jersey, 2013-2017 inclusive of baseline SCr and eGFR values 12-18 months preceding hospital admission. We examined AKI events (KDOQI criteria, duration 7 days or less), length of stay, AKD (persistent AKI based on SCr during Days 8 to 89 post-AKI start date), incident CKD (patients with baseline eGFR <60ml/min/1.73m2), and CKD progression (eGFR ≥5 ml/min below baseline eGFR).


Of 282,418 patient admissions, we identified 53,741 hospital admissions characterized by AKI events (19.0%). Length of stay (LOS) was increased following an AKI event (5.8 days) and exceeded 7 days in 24.7% of AKI patients versus a LOS of 3.7 days in non-AKI patients. Among admissions with AKI events, AKI transitioned to acute kidney disease in 38.2% of occurrences. Moreover in 35,190 patients admitted with a baseline eGFR ≥60 ml/min, 18.8% of patients developed incident CKD following either AKI or AKD within 1 year of the AKI start date. Combining AKI and AKD occurrences in 9,245 patients with baseline CKD prior to hospital admission, 29.0% of patients exhibited post-AKI/AKD progression of their CKD within 1 year of the AKI event.


Hospital-associated acute kidney injury is observed to occur in conjunction with increased hospital length of stay, a relatively high transition rate to acute kidney disease, and both incident and progression of chronic kidney disease within 1 year of an event. Close clinical follow-up of AKI survivors is needed to promote renal recovery and/or delay progression of kidney disease.


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