Abstract: SA-PO166
Recovery Patterns After AKI Differentiate Risk of Long-Term Adverse Kidney Outcomes
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - III
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Bhatraju, Pavan K., University of Washington, Seattle, Washington, United States
- Zelnick, Leila R., Kidney Research Institute, Seattle, Washington, United States
- Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
- Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
- Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
- Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
- Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
- Liu, Kathleen D., University of California at San Francisco School of Medicine, San Francisco, California, United States
- Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States
- Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States
- Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
- Himmelfarb, Jonathan, Kidney Research Institute, Seattle, Washington, United States
- Wurfel, Mark M., University of Washington, Seattle, Washington, United States
Background
Whether the trajectory of kidney function 72 hours after AKI informs long-term clinical outcomes, including CKD, dialysis and death, is unknown.
Methods
We prospectively enrolled patients who survived 90 days after hospitalization with or without AKI in ASSESS-AKI. Resolving AKI was defined as a decrease in SCr of 0.3 mg/dL or 25% from maximum in the first 72 hours after AKI diagnosis. Non-resolving AKI was defined as all AKI cases not meeting the ‘resolving’ definition. The primary outcome was a composite of major adverse kidney events (MAKE), defined as incident or progressive CKD, incident dialysis or death. Time to event analyses were completed conditioning on: demographics, comorbidites and KDIGO stage of AKI.
Results
We evaluated 772 participants with AKI and 831 participants without AKI over a median of 4.8 years. Among the AKI group, 479 (62%) had a resolving AKI pattern and 294 (38%) had a non-resolving pattern. The unadjusted incidence rate for MAKE was 5.5 events per 100 patient years in participants without AKI, 11.1 events in resolving AKI and 15.4 events in non-resolving AKI (Figure 1). The adjusted hazard ratio (aHR) for MAKE was higher for both resolving (aHR, 1.76; 95% CI, 1.17 to 2.63; p=0.006) and non-resolving (aHR 2.54; 95% CI, 1.69 to 3.81; p<0.001) AKI compared to participants without AKI. Within the AKI population, non-resolving AKI was associated with a 45% greater risk of MAKE (95% CI, 17% to 78% greater; p<0.001) compared to resolving AKI. The higher risk of MAKE in non-resolving AKI was due to a higher risk of incident and progressive CKD.
Conclusion
The 72-hour time period post AKI diagnosis distinguishes the risk of MAKE. The identification of AKI recovery patterns may improve patient risk stratification, facilitate prognostic enrichment in AKI clinical trials, and recognize patients who may benefit from nephrology consultation.
Funding
- NIDDK Support