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Abstract: TH-PO069

Novel Algorithm for AKI Detection in Outpatient Settings

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Author

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

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

Methods

The occurrence of AKIOPT were analyzed retrospectively among CKD patients who were enrolled into the pre-dialysis care program in a tertiary hospital in Taiwan. AKIOPT 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 AKIOPT 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 AKIOPT were 1.78 (95% CI, 1.50, 2.12) and 1.50 (1.32, 1.71), respectively, compared with those without history of AKIOPT. For 1-year and overall risk of all-cause mortality, patients with AKIOPT had respectively a 120% (95% CI 73-182%) and 74% (95% CI, 48-106%) higher risk than those without AKIOPT. This statistical inference remained robust in CEM analysis. We discovered a complete reversal in the eGFR slope before and after the AKIOPT 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 AKIOPT 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 AKIOPT 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.