Abstract: SA-PO871
Nephrotoxin Exposure After Hospital Discharge Predicts Development of CKD Among AKI Survivors
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Schreier, Diana J., Mayo Clinic, Rochester, Minnesota, United States
- Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States
- Rule, Andrew D., Mayo Clinic, Rochester, Minnesota, United States
- Lieske, John C., Mayo Clinic, Rochester, Minnesota, United States
- Kane-Gill, Sandra, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Chamberlain, Alanna, Mayo Clinic, Rochester, Minnesota, United States
- Mara, Kristin C., Mayo Clinic, Rochester, Minnesota, United States
- Barreto, Erin F., Mayo Clinic, Rochester, Minnesota, United States
Background
Survivors of acute kidney injury (AKI) are at high risk of progression to chronic kidney disease (CKD). A potentially modifiable risk factor for subsequent CKD is exposure to drugs with potential nephrotoxicity. The objective of this study was to evaluate the association between the prescription of potentially nephrotoxic medications in AKI survivors at hospital discharge and the subsequent risk of new or worsening CKD, readmission with AKI or death.
Methods
We conducted a population-based cohort study of adult Olmsted County, MN residents who developed AKI while hospitalized between 1/1/2006 and 12/31/2014 using data from the Rochester Epidemiology Project (REP). The REP links medical records across care providers in Olmsted County, making population-based studies possible. The cohort included those with a hospitalization complicated by AKI who survived to discharge. Discharge medication lists, prescription records, and clinical notes were queried for prescription of potentially nephrotoxic medications over the 3 years after discharge. New or worsening CKD was identified by both diagnosis codes and calculated estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2. Cox proportional hazards models were fit to evaluate the association between exposure to potentially nephrotoxic medications and the study outcomes. A validated CKD risk prediction score was used to adjust the Cox models for the baseline risk of CKD following AKI.
Results
Among 2,894 AKI survivors, 2143 (74%) received a potentially nephrotoxic medication at discharge. Those that received these drugs experienced a significantly higher risk of new or worsening CKD during 3-years of follow-up (cumulative incidence 71% vs. 57%; HR 1.44: 95% CI 1.28, 1.63). Patients prescribed potentially nephrotoxic medications after discharge also experienced a significantly greater risk of the composite endpoint of CKD, AKI readmission, or death within 3 years of discharge (HR 1.32: 95% CI 1.20, 1.46).
Conclusion
In this population-based cohort study, we observed that AKI survivors prescribed potentially nephrotoxic medications at hospital discharge were at significantly greater risk for CKD development, AKI readmission, and death in the 3 years following hospitalization.
Funding
- Private Foundation Support