Kidney Week

Abstract: FR-OR016

Clinical Outcomes and Disparities Associated with ESKD due to AKI in the United States

Session Information

• AKI: Epidemiology, Processes of Care, and Outcomes
  November 08, 2019 | Location: 201, Walter E. Washington Convention Center
  Abstract Time: 05:30 PM - 05:42 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States

Silvi Shah, MD, MS, FASN



Silvi Shah, MD, MS is an assistant professor in the Division of Nephrology and Hypertension at the University of Cincinnati, Ohio. After completing her residency in Internal Medicine at University at Buffalo (SUNY), she completed her general nephrology fellowship from Cleveland Clinic Foundation, Ohio followed by a transplant nephrology fellowship at the University of Alabama in Birmingham and masters in clinical and translational research at the University of Cincinnati. Dr. Shah’s research interests focus on women’s health in kidney disease including pregnancy, disparities in kidney disease, cardiovascular health in kidney disease, and innovative education tools in nephrology. She is currently involved in investigator-initiated clinical and translational research studies and national clinical trials. Dr. Shah has authored several peer-reviewed manuscripts and has presented at various premier international and national meetings. She is a peer reviewer for journals like JAMA, Transplantation and the American Journal of Kidney Disease. Dr. Shah leads the American Society of Nephrology’s “Women’s Health and Research in Nephrology” community and is an executive member of the American Society of Transplantation’s “Young Faculty Community of Practice”. She currently serves as a councilor in Women in Nephrology and in the American Society of Nephrology’s media and communication committee. She is a fellow of the American Society of Nephrology and American College of Physicians. Dr. Shah also has a keen interest in the use of social media in medical education. She currently serves as a faculty member in the Nephrology Social Media Collective, and NephJC (online nephrology journal club). She enjoys teaching and mentoring medical students, residents and fellows. Please contact Dr. Shah at shah2sv@ucmail.uc.edu. Follow her on twitter @silvishah

• Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States

Anthony C. Leonard,

• Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States

Karthikeyan Meganathan,

• Christianson, Annette, Cincinnati VA, Cincinnati, Ohio, United States

Annette Christianson,

• Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States

Charuhas V. Thakar,

Background

Acute kidney injury (AKI) is associated with increased mortality. Mortality in end-stage kidney disease (ESKD) patients is highest during the first year of dialysis. ESKD due to AKI is common, but little is known about the rate of recovery and its impact on long-term outcomes in incident dialysis patients.

Methods

We evaluated a retrospective cohort of 1,045,540 incident ESKD patients from the United States Renal Data System. Using Cox proportional hazard models, we examined the impact of AKI as the ESKD cause on the primary outcome of all-cause mortality. Additionally, we determined the impact of sex and race on renal recovery and associated mortality in patients with AKI as the ESKD cause.

Results

Mean age was 63±15 years. Of the study cohort, 3.3% had ESKD due to AKI. The majority were men (58.1%) and white (75.8%). One-year all-cause mortality was 21.8%. Compared to ESKD due to diabetes (46% of the sample, the most common cause), ESKD due to AKI was associated with changes in the adjusted mortality across the follow-up period – higher adjusted hazards of mortality in first 0-3 months following dialysis initiation (HR, 1.27; 95% CI, 1.23-1.31) and 3-6 months (HR, 1.15; 95% CI, 1.11-1.20), followed by lower adjusted hazards of mortality at 6-12 months (HR, 0.93; 95% CI, 0.90-0.97) that continued to decrease through 84-96 months of follow up (HR, 0.46; 95% CI, 0.41-0.52). Of the patients with ESKD due to AKI, 35.3% eventually recovered their kidney function. The median time of recovery was 2 months (IQR, 1.2-3.5 months). Women had lower adjusted hazards of renal recovery than did men (HR, 0.86; 95% CI, 0.82-0.89). As compared to whites, blacks (HR, 0.67; 95% CI, 0.65-0.71), Asians (HR, 0.77; 95% CI, 0.66-0.90), and Hispanics (HR, 0.80; 95% CI, 0.74-0.86) had a lower likelihood of renal recovery. Heart failure and diabetes were other risk factors associated with non-recovery.

Conclusion

About one-third of patients with ESKD due to AKI recover kidney function. Mortality risk changes across the follow-up period in patients with ESKD due to AKI. Women have a 14% lower likelihood of recovery than men. Black, Asian, and Hispanic patients have a lower likelihood of recovery than do white patients. The study suggests that the need for customized dialysis care in patients with ESKD due to AKI.