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Kidney Week

Abstract: FR-PO011

Association Between Pre-ESRD Outpatient AKI and Post-ESRD Mortality

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Dashputre, Ankur A., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Gaipov, Abduzhappar, National Scientific Medical Center, Astana, Kazakhstan
  • Kar, Suryatapa, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Gatwood, Justin, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Obi, Yoshitsugu, University of California Irvine, Irvine, California, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Acute kidney injury (AKI) often occurs in patients with advanced CKD. The incidence of AKI and its impact on outcomes in hospitalized patients has been reported. However, information about the association between pre-ESRD outpatient AKI (oAKI) and post-ESRD outcomes is lacking.

Methods

We examined 54,085 US veterans who transitioned to dialysis during 2007-2014 and had serum creatinine measured in three years preceding the dialysis initiation. oAKI was defined as a 50% increase in creatinine compared to the preceding creatinine value. We compared patients with no oAKI (N=38,348) to patients who had 1 oAKI (N=12,399) and patients who had ≥2 oAKI (N=3,338). The association between pre-ESRD oAKI and post-ESRD all-cause mortality was assessed using Cox proportional hazards model adjusted for demographics, comorbidities, medications, nephrology care, number of outpatient visits, cumulative length of hospitalizations and vascular access type.

Results

The mean (SD) age of the cohort was 70 (11) years; 98% were male; 27% were African American; and 75% were diabetic. Patients with oAKI were younger (age 71 (11) vs. 67 (11) vs. 64 (11) years in patients with no vs. one vs. ≥2 oAKI events). Also, patients with oAKI displayed significantly higher multivariable adjusted mortality than patients without oAKI, with incrementally higher risk observed in patients experiencing ≥2 episodes of oAKI [Figure]. The hazard ratios (95%CI) associated with 1 and ≥2 (vs. no) oAKI were 1.03 (1.00-1.06) and 1.07 (1.03-1.13), respectively.

Conclusion

Prior AKI event in outpatient setting is associated with higher risk of all-cause mortality in advanced CKD patients who transition to maintenance dialysis therapy. Clinical trials are indicated to examine whether preventing AKI can improve CKD outcomes.

Funding

  • NIDDK Support