Kidney Week

Abstract: FR-OR012

Relationship of Acute Kidney Disease (AKD) to Long-Term Outcomes After AKI

Session Information

• AKI: Epidemiology, Processes of Care, and Outcomes
  November 08, 2019 | Location: 201, Walter E. Washington Convention Center
  Abstract Time: 04:42 PM - 04:54 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Selby, Nicholas M., University of Nottingham, Derby, United Kingdom

Nicholas M. Selby, MBBS, MD

Dr Selby studied medicine at the University of Nottingham, UK, graduating in 1998, and after completing post-graduate training in the East Midlands was appointed a full-time NHS consultant nephrologist at the Royal Derby Hospital in 2009. In 2015 he was appointed Associate Professor of Nephrology at the University of Nottingham, based in the Centre for Kidney Research and Innovation (www.nottingham.ac.uk/research/groups/renal Twitter:@CKRIresearch), Royal Derby Hospital Postgraduate Medical School. Dr. Selby is a clinical academic with primary interests in Acute Kidney Injury (AKI), Magnetic Resonance Imaging (MRI) of the kidney and the haemodynamic consequences of dialysis. He led the development of one of the first e-alert systems for AKI in the UK and is CI on several investigator-instigated studies in these areas including the Tackling AKI study. Since 2011 Dr Selby has been awarded peer reviewed grant funding from NIHR, MRC, the Health Foundation, Kidney Research UK and British Renal Society. He has published over 75 peer-reviewed articles. Dr Selby has several national AKI roles, including leadership of the AKI Clinical Study Group that sits within the UK Kidney Research Consortium, the co-chair of the UK Renal Imaging Network and programme board of the NHS England ‘Think Kidneys’ programme.

• Kazmi, Isma, University of Nottingham, Derby, United Kingdom

Isma Kazmi,

• Packington, Rebecca A., University Hospitals of Derby and Burton, Derby, United Kingdom

Rebecca A. Packington,

• Monaghan, John, University Hospitals of Derby and Burton, Derby, United Kingdom

John Monaghan,

Group or Team Name

• ARID study investigators

Background

Acute Kidney Disease (AKD) is a term that has been advocated by the Acute Disease Quality Initiative (ADQI) and others to describe ongoing renal dysfunction after AKI that persists beyond 7 days. Currently there is very little available epidemiological data regarding AKD. We sought to study its relevance to long term renal and patient outcomes.

Methods

All patients from the AKI arm of a large parallel group cohort study of AKI were included in this study. Participants were recruited following hospitalisation and followed up prospectively. Renal function, proteinuria and patient outcomes were assessed at 3 months, 1 year and 3 years after AKI. CKD progression was defined as a ≥25% decline in eGFR from baseline with a decline in eGFR stage. Patients were categorized into three groups depending on duration of AKI: AKI that resolved in <48hours (rapid recovery, r-AKI), AKI duration of 2-6 days (persistent AKI, p-AKI) and AKD (AKI duration ≥7 days). Outcomes were compared across these three groups.

Results

In total, 506 patients with AKI were studied. There were 109 (22%) in r-AKI group, 302 (60%) in p-AKI group and 95 (19%) with AKD. Patients in the AKD group had lower baseline eGFR and a higher proportion of AKI stage 3.
CKD progression was more common in AKD group as compared to other two groups. At one year, CKD progression was 46% in AKD group versus 11% (r-AKI) and 22% (p-AKI), p<0.001. eGFR was lower in AKD group at all time-points; at year 3, eGFR was 66.9±23ml/min, 60.1±20ml/min and 53±20ml/min in r-AKI, p-AKI and AKD groups respectively, p<0.001. Proteinuria was more common and more severe in AKD. Hospital readmission occurred more frequently in the AKD group.
Using binary logistic regression analysis adjusting for age, gender, diabetic status, baseline eGFR, AKI stage and biochemical variables, AKD remained independently associated with CKD progression at 1 (OR 5.4, 95% CI 2.2-13.2, p<0.001) and 3 years (OR 2.2, 95%CI 1.0-4.6, p=0.04).

Conclusion

AKD is common and is associated with a number of clinical variables including chronic comorbidities and markers of AKI severity. However, AKI duration remains an important independent determinant of subsequent progression of kidney disease, and AKD appears to be a useful way to categorize this to identify patients at higher risk of long-term adverse outcomes.