Abstract: FR-PO008
Predictors of Recovery of Kidney Function and Transition to ESKD in Patients on Outpatient Dialysis for AKI
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 08, 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
- Weinhandl, Eric D., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Dalrymple, Lorien S., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Sun, Yuping, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Ofsthun, Norma J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Hymes, Jeffrey L., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background
Most patients initiating outpatient hemodialysis (OP HD) for acute kidney injury requiring dialysis (AKI-D) recover function or transition to end-stage kidney disease (ESKD) within 3 months. Identifying factors predisposing patients to either outcome may improve clinical care processes. We assessed associations of baseline patient characteristics and biochemistry at initiation of OP HD for AKI-D with competing risks of recovery of kidney function and transition to ESKD.
Methods
We analyzed patients initiating OP HD for AKI-D in a Fresenius Kidney Care (FKC) dialysis facility between May 1, 2017, and December 31, 2018, excluding those discharged from FKC facilities within 7 days of initiation of OP HD or with incomplete biochemical data. We followed patients to the earliest of recovery of kidney function, transition to ESKD, death, or loss to follow-up (typically, transfer to another dialysis provider), with end of follow-up on March 31, 2019. We used Fine-Gray regression to model subdistribution hazards of recovery of function and transition to ESKD, as a function of age, sex, and biochemistry measured within 7 days of initiation of OP HD; death was classified as a competing risk.
Results
The cohort comprised 12,221 patients. During follow-up, 4786 (39%) recovered kidney function, 5606 (46%) transitioned to ESKD, and 1136 (9%) died. Adjusted hazard ratios of recovery of function and transition to ESKD per standard deviation (SD) of each factor are displayed in the table.
Conclusion
Younger age, female sex, lower serum creatinine, lower serum potassium, higher serum phosphorus, and lower serum parathyroid hormone are most strongly associated with recovery of kidney function after initiation of OP HD for AKI-D, whereas higher serum creatinine is most strongly associated with transition to ESKD.