Abstract: FR-PO067
Three-Year Outcomes After AKI in a Prospective Cohort: Effects on CKD, Survival, and Cardiovascular Events
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Kazmi, Isma, University of Nottingham, Derby, United Kingdom
- Packington, Rebecca A., University Hospitals of Derby and Burton, Derby, United Kingdom
- Monaghan, John, University Hospitals of Derby and Burton, Derby, United Kingdom
- Selby, Nicholas M., University of Nottingham, Derby, United Kingdom
Group or Team Name
- ARID study investigators
Background
Acute Kidney Injury (AKI) is associated with adverse long-term outcomes. There is a need for prospective studies to identify those at highest risk and to improve understanding of the effect size across different outcomes and patient groups. Here we report three-year outcomes from a large prospective parallel group cohort study.
Methods
In a single UK centre, hospitalised patients who sustained AKI were recruited and matched 1:1 with controls (hospitalised patients without AKI) for age, baseline eGFR stage and diabetes. Biochemical parameters including renal function and proteinuria were measured at 3 months, 1 year and 3 years following index hospitalisation. CKD progression was defined as ≥25% decline in eGFR with decline in eGFR stage, and a composite renal endpoint as a doubling of serum creatinine, eGFR<15ml/min or initiation of renal replacement therapy.
Results
1125patients were recruited of whom 866 were successfully matched. There was no difference between AKI and control groups in age (71 yrs (IQR 14) vs. 71 yrs (IQR 13), p=0.7) or baseline eGFR (70.3±20ml/min vs 69.6±20ml/min, p=0.58). Two-thirds of AKI episodes were stage 1 with median duration 3 days (IQR 3).
Mean eGFR was lower at all-time points in AKI group. At 3 years, eGFR was 61±20ml/min in AKI group versus 70±20ml/min in controls (p<0.001), and CKD progression occurred in 26.7% of the AKI group, as compared to 6.6% in the control group (p<0.001). The greatest odds of CKD progression rates were seen at three months, with progressive attenuation over time. Proteinuria was also more common and more severe in the AKI group at each time point. The composite renal endpoint occurred in 3% of AKI group versus 0.7% of controls (OR 4.4, 95% CI 1.3-15.7, p=0.012). Mortality rates were also significantly higher in the AKI group (15.7% versus 9.7%, p=0.008), as were heart failure events. Binary logistic regression demonstrated that presence of AKI and non-recovery by 90 days had independent associations with CKD progression.
Conclusion
AKI is associated with long term renal dysfunction, proteinuria, higher rates of ESKD and increased mortality. This is true even in a general hospitalised population in which a majority of patients had AKI stage 1. Non-recovery of renal function by 90 days is an important predictor of subsequent CKD.
Funding
- Private Foundation Support