Kidney Week

Abstract: SA-PO154

Severity of Sepsis-Associated Acute Kidney Disease and 90-Day Survival

Session Information

• AKI: Epidemiology, Risk Factors, Prevention - III
  November 09, 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

• Priyanka, Priyanka, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Priyanka Priyanka,

• Wilfret, David, Atox Bio, Ltd, Ness Ziona, Israel

David Wilfret,

• Shirvan, Anat, Atox Bio, Ltd, Ness Ziona, Israel

Anat Shirvan,

• Dankner, Wayne M., Atox Bio, Ltd, Ness Ziona, Israel

Wayne M. Dankner,

• Kellum, John A., The University of Pittsburgh, Pittsburgh, Pennsylvania, United States

John A. Kellum,

Background

Current evidence suggests that survival following sepsis with AKI (S-AKI) is strongly associated with recovery of renal function by hospital discharge. Acute Disease Quality Initiative (ADQI) consensus classifies persistent renal dysfunction for >7 days as acute kidney disease (AKD) with staging as per AKI using serum creatinine or dialysis. However, the relationship between AKD stage and the risks of death, chronic dialysis or persistent renal dysfunction over the following three months are unknown. Further, it is unknown if 14 or 28 day AKD status reflects 90 day status. Here, we examined the relationship between AKD at days 14, 28 and outcomes at 90 day in patients with sepsis.

Methods

We conducted a retrospective cohort study of patients admitted to any of 16 hospitals with in the University of Pittsburgh Medical Center between October 2008 and May 2014. We included critically ill adult patients who had s-AKI (stage 2-3 as per KDIGO criteria occurring after sepsis). Sepsis was identified using Sepsis-3 criteria plus an ICD9 code. We staged AKD at day 14 and 28 from first max AKI stage. Our primary outcome was survival at 90 day. We also assessed rates of dialysis and persistent renal dysfunction (>150% of baseline creatinine) as well as the composite of all three—major adverse kidney events (MAKE) at 90 day.

Results

Of 121,817 patients, 10,999 met our definition of s-AKI. Median age was 67 (IQR, 56-79) years., 50.2% were male, estimated baseline glomerular filtration rate was 70.12 (IQR, 47.19 – 93.44) mL/min/1.73m², APACHE III score was 61 (IQR, 46 – 78). Among the 2,402 (27.6%) patients known to have AKD on day 14, 1,897 (79%) met MAKE criteria by day 90. However, of the 2,354 (26.8%) patients known to have AKD on day 28, 2,031 (86.3%) met MAKE criteria by day 90. Overall, 182 patients (7.6%) recovered renal function between day 14 and day 28.

Conclusion

Permanent loss of renal function is more accurately assessed at day 28 compared to day 14 as well as risks for dialysis and persistent renal dysfunction in patients with s-AKI. However, day 14 evaluation may allow an early opportunity to focus attention on those patients who have not yet demonstrated evidence of renal function recovery.

Funding

• Commercial Support –