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Kidney Week

Abstract: PO0093

AKI and CKD Distribution in the Novel Clinical Phenotypes for Sepsis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Molinari, Luca, Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Del Rio-Pertuz, Gaspar, Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Peerapornratana, Sadudee, Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, United States
  • Gomez Danies, Hernando, Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Kellum, John A., Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
Background

Sepsis is the most common cause of Acute Kidney Injury (AKI) in critically ill patients. Four clinical phenotypes (alpha, beta, gamma, delta) of sepsis have been recently described. Our objective was to investigate which of these sepsis phenotypes were associated with severe AKI, chronic kidney disease (CKD), AKI with CKD, and acute kidney disease (AKD).

Methods

We examined the 4 phenotypes using patient data from a previously published multicenter sepsis trial. After excluding patients with end-stage kidney disease and missing data, we analyzed 1243 patients with septic shock. We described the presence of severe AKI within the first 24 hours defined as KDIGO stage 2 or 3 or stage 1 with [TIMP-2]●[IGFBP7] at 6 hours >2.0. AKD was defined for patients with severe AKI as the presence of any AKI on day 7 or, if death occurred before 7 days, death without AKI recovery. The Chi-square test was used to compare distributions between groups, if p<0.05 then a pairwise comparison between groups was made using the Chi-square test adjusted with Bonferroni correction.

Results

We found a total of 633 patients with severe AKI (53.6%) within 24h. The rate of severe AKI at 24h was different across phenotypes being highest in the delta and beta phenotypes (80.8% and 73.6% respectively), and lowest in the alpha phenotype (30.1%, overall p<0.0001). CKD was most common in the beta phenotype (52.0%, overall p<0.0001) while in the others was lower (31.4% in alpha, 28.6% in gamma, and 35.0% in delta). The highest prevalence of AKI with CKD was again in the beta phenotype (52.8%), compared to alpha (25.0%), gamma (26.6%), or delta (34.8%, p<0.0001). AKD occurred more often in the delta (57.4%) and beta (50.0%) phenotypes compared to alpha (32.7%) and gamma (40.1%, p=0.0002).

Conclusion

Severe AKI was significantly more common among patients with beta and delta phenotypes. However, the beta phenotype had a higher level of underlying CKD that predisposed to new AKI. Alpha and gamma phenotypes not only had lower rates of AKI, but these cases were less likely to progress to AKD.

Funding

  • NIDDK Support