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Kidney Week

Abstract: TH-PO026

Frequency and Consequences of AKI in Patients with CKD in Public Nephrology Practices in Queensland, Australia

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Hoy, Wendy E., Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Zhang, Jianzhen, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Wang, Zaimin, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  • Cameron (Salisbury), Anne, CKD.QLD and the NHMRC CKD.CRE, Brisbane, New South Wales, Australia
  • Healy, Helen G., Queensland Health, Brisbane, Queensland, Australia
  • Venuthurupalli, Sree Krishna, Queensland Health, Toowoomba, Queensland, Australia
  • Mallett, Andrew John, Queensland Health, Brisbane, Queensland, Australia

Group or Team Name

  • NHMRC CKD.CRE and CKD.QLD Collaborative
Background

It is recognised that acute kidney injury (AKI) contributes to, and complicates, CKD and can exacerbate its progression. We describe acute kidney injury (AKI) documented in hospital episodes in patients enrolled in the CKD.QLD registry, based in the public nephrology sector in Queensland.

Methods


Queensland Health supplied data on CKD.QLD patients on admissions to all Queensland hospitals, public and private, as well as associated costs, and deaths, from May 2011 to June 2016. We describe the frequency of AKI and associated conditions, recognised by ICD codes.

Results


Among 6,365 CKD.QLD patients, 2,198 (34.5%) had a total of 4,711 hospital encounters with an AKI diagnosis. 550 patients had three or more AKI-related admissions. 64.9% of AKI admissions were through the emergency department. People with AKI were somewhat older (68.2 vs 64.6 yr) and more often male (57.1% vs 52%), than those without AKI, p<0.001 for both. Leading diagnoses associated with AKI were congestive heart failure, urinary tract infection, myocardial infarction, dehydration, pneumonia and COPD, gastroenteritis/colitis, and sepsis, and diabetic nephropathy was the leading underlying renal condition. Of those with AKI, 553 (25.2%) subsequently died in the 5 year interval and 238 (10.8%) started renal replacement therapy (RRT), compared with 282 (12.8%) who died and 295 (13.4%) who started RRT among those who did not have AKI, p<0.001 for each. Adjusted for all other significant factors, the hazard ratio (95%CI) of AKI patients relative to those without AKI for death without RRT was 3.32 (CI 2.8-3.9), p<0.001, and for RRT was 1.21 (CI 1-1.5), p=0.06.

Conclusion

AKI that comes to clinical attention is very common among these CKD patients. It usually presents through unplanned, emergency admissions. It is associated with strikingly increased rates of death but only marginally increased rates of RRT. Preventable causes of AKI should be better understood and addressed.

Funding

  • Commercial Support