Kidney Week

Abstract: TH-PO069

Novel Algorithm for AKI Detection in Outpatient Settings

Session Information

• AKI: Epidemiology, Risk Factors, Prevention - I
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Author

• Kuo, Chin-Chi, China Medical University Hospital, Taichung, Taiwan

Chin-Chi Kuo,

Background

Existing acute kidney injury (AKI) diagnostic criteria is restricted to inpatients. We proposed an AKI algorithm for outpatients(AKI_OPT) and evaluated how AKI_OPT modifies the course of chronic kidney disease (CKD).

Methods

The occurrence of AKI_OPT were analyzed retrospectively among CKD patients who were enrolled into the pre-dialysis care program in a tertiary hospital in Taiwan. AKI_OPT was detected by the definition of a 50% increase in serum creatinine (S-Cre) or a fall in eGFR by 35% in the 180-day period prior to pre-dialysis care program enrollment. Outcomes were progression to end-stage renal disease (ESRD) and all-cause mortality. The association analyses were performed using multiple Cox regression and coarsened exact matching (CEM) analysis.

Results

Among the total of 6046 patients, 31.5 % (1905 patients) had ever developed AKI_OPT within the 180-day period before the enrollment. The fully adjusted hazard ratios (aHRs) of the 1-year and overall risk of ESRD among patients with preceding AKI_OPT were 1.78 (95% CI, 1.50, 2.12) and 1.50 (1.32, 1.71), respectively, compared with those without history of AKI_OPT. For 1-year and overall risk of all-cause mortality, patients with AKI_OPT had respectively a 120% (95% CI 73-182%) and 74% (95% CI, 48-106%) higher risk than those without AKI_OPT. This statistical inference remained robust in CEM analysis. We discovered a complete reversal in the eGFR slope before and after the AKI_OPT from −10.61 ± 0.32 to 0.25 ± 0.30 mL/min/1.73 m² per year; however, the loss of kidney function is not recovered (Figure).

Conclusion

The new AKI_OPT diagnostic algorithm fits the outpatient setting and provides a prognostic significance in patients with CKD.

eGFR slope (red line) with the light red shaded area representing 95% confidence intervals before and after the AKI_OPT event, modeled using the growth piecewise linear mixed model by incorporating random effects. Blue and orange points represent eGFR measurements before and after enrollment into pre-ESRD program.

Funding

• Government Support - Non-U.S.