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Kidney Week

Abstract: PO0086

Traditional and Non-Traditional Risk Factors and Their Influence on In-Hospital Mortality in Community- vs. Hospital-Acquired AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Acosta-Ochoa, Maria Isabel, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
  • Coca, Armando, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
  • Sanchez Gil, Jimmy R., Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
  • Mendiluce, Alicia, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
Background

Many studies compare hard outcomes in Community Acquired (CA-AKI) vs. Hospital Acquired AKI (HA-AKI), but few works contrast how various risk factors (RF) impact in-hospital mortality risk in both groups.

Methods

Retrospective study of in-patients with AKI. AKI was classified by KDIGO-2012 Stages. CA-AKI occurred in the first 48h, and HA-AKI >48h after admission. We compared clinical and epidemiological features, and the traditional RF (age, Charlson's Index (ChI), ICU entrance, and AKI severity). We analyzed hyponatremia Max (Na <134 associated with peak SCr) (HNa Max), anemia Max (Hb <10 with peak SCr), and AKI etiology as non-traditional RF. All RF relationship with mortality was calculated with a multivariate Cox regression.

Results

We included 1269 cases, 69% in the CA-AKI group. The HA-AKI group showed a higher ChI, had longer hospital stay, were less frequently admitted to medical wards, and less HD dependent at discharge. Mortality was significantly higher among HA-AKI vs. CA-AKI (31% vs.18% p<0.001). See Table 1. Traditional RF correlated with higher risk of death in both groups. Hypertension, heart failure and anemia Max were associated with mortality in CA-AKI but not in HA-AKI. On the other side, HA-AKI had a higher risk of death associated with HNa, which was not significant among CA-AKI patients. See Figure 2.

Conclusion

We found that HA-AKI is more deadly than CA-AKI (consistent with previous studies), but shows lesser HD dependence at discharge. The traditional RF: older age, higher ChI, ICU admission, and AKI stage 3 influenced in-hospital mortality in both groups. Non-traditional RF showed an heterogeneous influence on outcomes according to AKI type, probably due to diverse baseline characteristics, evolution time, and AKI etiologies between cohorts. We conclude that these novel associations (e.g. anemia and HNa) should be explored and modifiable factors should be tackled in order to prevent AKI mortality.