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Kidney Week

Abstract: SA-PO151

Predicting Major Adverse Kidney Events in the First Year After AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • See, Emily J., Austin Health, Melbourne, Victoria, Australia
  • Polkinghorne, Kevan, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
  • Johnson, David W., Princess Alexandra Hospital, Greenslopes, Queensland, Australia
  • Toussaint, Nigel David, The Royal Melbourne Hospital, Parkville, Victoria, Australia
Background

Acute kidney injury (AKI) is a common complication of hospital admission, and survivors are at increased future risk of major adverse kidney events (MAKE), including chronic kidney disease (CKD), end-stage kidney disease (ESKD) and death. High-risk patients may benefit from specialist follow-up; however, the factors associated with increased risk have not been reported.

Methods

We conducted a retrospective study of all adult patients admitted with AKI to a single centre between 1 January 2012 and 31 December 2016. Cox regression models were performed to examine the primary outcome, which was the development of a MAKE in the first year following hospital discharge. The secondary outcomes (CKD, ESKD, and death) were studied using Cox and competing risk regression analyses. Candidate predictor variables included patient demographics, comorbidities, and laboratory values available at the time of hospital discharge.

Results

Of 2,101 patients included in the study, 767 patients (37%) developed a MAKE within the first year. MAKE occurred more frequently in patients who were older (HR 1.02 95% CI 1.01-1.02) and in those with a history of chronic heart failure (HR 1.41 95% CI 1.19-1.67), liver disease (HR 1.68 95% CI 1.39-2.03), and either non-metastatic (HR 1.44 95%CI 1.14-1.82) or metastatic (HR 2.26 95% CI 1.80-2.83) malignancy. They were also more common in patients with a greater severity of AKI (stage 2 HR 1.38 95% CI 1.16-1.64; stage 3 HR 1.62 95% CI 1.31-2.01) and in those with a higher serum creatinine level at discharge (HR 1.01 95% CI 1.00-1.01). Female sex (SHR 1.54 95% CI 1.27-1.88) and hypertension (SHR 1.28 95% CI 1.04-1.58) were additional risk factors for the development of CKD.

Conclusion

A significant number of patients with AKI will develop a MAKE within the first year. Clinical variables available at the time of discharge could be used to stratify risk and identify patients who may benefit from specialist follow up.