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Abstract: TH-PO084

Increased Mortality Among AKI Patients Attending the Emergency Department: A Retrospective Hospital-Based Cohort Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Al- Chidadi, Asmaa Y M, North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, United Kingdom
  • Choi, Soha, North West Anglia NHS Trust, Peterborough, United Kingdom
  • Stathi, Dimitra, North Anglia Trust, Peterborough, United Kingdom
  • Chasimpha, Steady, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • Arsalanizadeh, Bahareh, North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, United Kingdom
  • Kar, Sourjya, North West Anglia NHS Trust, Peterborough, United Kingdom
  • Pierres, Floyd, North West Anglia NHS Trust, Peterborough, United Kingdom
Background

It is well documented that acute kidney injury (AKI) is associated with increased inpatient mortality, but this association is poorly described in the emergency department (ED) setting.

Methods

Between April 2016 and March 2017, we randomly selected electronic records of 365 patients from 1695 presented to ED with AKI using an electronic AKI reporting system, and compared them to 379 randomly selected patients without AKI. The cohort was followed up till the end of April, 2019. Mortality as well as other demographic characteristics were compared.

Results

Incidence of AKI was 5.3%. AKI was associated with significantly higher risk of death 50.27% compared with 22.96% amongst those with no AKI (p< 0.001). Those whose AKI worsened while inpatients had a higher mortality risk of 63.6% compared to 49.09% in these whoms AKI did not progress to a higher stage, although it did not reach statistical significance (p=0.11). Risk of inpatient mortality was significantly higher amongst the AKI group (34.4% vs 0.0% P=<0.0001). Risk of readmission within 30 days did not significantly differ between the 2 groups (16.5% vs 21.4%, P=0.14). At 12 months, 71.9% of the AKI group developed CKD progression or de novo CKD compared to 54.6% in controls (P=<0.0001). Average follow-up time was 3.14 years. After adjusting for age, gender, ethnicity, 13 comorbidities, serum sodium and albumin, AKI was still independently associated with increased mortality (adjusted HR 1.93, CI 1.4-2.7). Hypoalbuminemia (HR 2.1 CI 1.5-2.9 P=<0.0001), being 75-84 years old (HR 1.7 CI 1.1-2.7 P=0.02), or over 85 years (HR 2.3 CI 1.5-3.5, P=<0.0001), as well as having at least one comorbidies (HR 1.5 CI 1.1-2.1, P=0.02) were all independently associated with mortality.

Conclusion

Presentation to ED with AKI is independently associated with inpatient deaths as well as overall mortality and morbidity.

Funding

  • Government Support - Non-U.S.