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Kidney Week

Abstract: TH-PO087

Risk Factors of AKI in Upper Urinary Tract Obstruction

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Sun, Bong gyun, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Yang, Jihyun, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Min, Hyeonjin, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Son, Young-Bin, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Choi, Eunho, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Lim, Kijoon, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Lee, Kyungmi, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Oh, Sewon, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Myung-Gyu, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  • Jo, Sang-Kyung, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
Background

Obstruction to urine flow occurs at any site in the urinary tract and development of post-renal acute kidney injury (AKI) depends on whether it is acute or chronic, unilateral or bilateral and presence of combined sepsis. However, incidence, etiologies, risk factors or prognosis of post-renal AKI in urinary tract obstruction are largely unknown due to paucity of extensive epidemiologic data.

Methods

We conducted a retrospective analysis of 1,784 patients who received percutaneous nephrostomy (PCN) due to upper urinary tract obstruction in 3 university hospitals in Korea from January 1, 2002 to August 16, 2018. AKI was diagnosed according to KDIGO AKI criteria and analyzed risk factors of AKI using multivariate logistic regression analysis.

Results

AKI developed in 79.9% of patients who underwent PCN. Patients with post-renal AKI were more likely to be male (50.4 vs 51.1%, p<0.01)), older (64 vs 57yrs,p<0.01) and associated with decreased baseline renal function (eGFR 72.88 vs 90.79 ml/min/1.73m2, p<0.01). Prevalence of hypertension (47.5 vs 35.5%, p<0.01)), ischemic heart disease (5.4 vs 2.3%, p=0.013), peripheral arterial occlusive disease (7.1 vs 3.9%, p=0.03), heart failure (4.5 vs 1.1%, p<0.01) or cancer (68.5 vs 53%, p<0.01) was significantly higher in patients with AKI compared with those without AKI. Mean hemoglobin level, protein, albumin and tCO2 level were significantly lower while uric acid, CRP and procalcitoning level were significantly elevated in patients with AKI. In multivariate logistic regression analysis, lower tCO2 (OR 0.835, 95% CI 0.716-0.975, p=0.022) and albumin level (OR 0.190, 95% CI 0.049-0.739, p=0.017), and high uric acid level (OR 2.004, 95% CI 1.252-3.208, p=0.004) were significantly associated with the development of AKI in these patients.

Conclusion

The incidence of AKI was very high (79.7%) in patients who underwent PCN due to upper urinary tract obstruction. Anemia, leukocytosis, hyperuricemia, and underlying hypertension are found to be independent risk factors for AKI with male predominancy.