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Kidney Week

Abstract: PO0009

Risk Factors for Mortality and Hospital Readmission Following AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Griffin, Benjamin R., Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
  • Wachsmuth, Jason, Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
  • Perencevich, Eli, Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
  • Reisinger, Heather, Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
  • Sarrazin, Mary Vaughan, Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
  • Jalal, Diana I., Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
Background

Acute kidney injury (AKI) occurs in over 20% of hospitalized patients and is associated with long-term morbidity and mortality. The purpose of this study is to identify risk factors for readmission for renal cause and mortality following a hospitalization with AKI in US Veterans.

Methods

AKI was defined as a creatinine increase of ≥0.3 mg/dL at or after admission to a VA hospital between 2013 and 2018. The primary outcomes were death and readmission for a renal indication. Proportional hazards frailty model was applied. Variables evaluated included demographics, comorbidities, and laboratory data. The final model was chosen based on clinical relevance and parsimony.

Results

From a cohort of 624,822 Veterans with AKI, 218,839 (35%) met inclusion criteria. Reasons for exclusion were <1 year of prior patient data (35%), missing serum creatinine values (14%), palliative status or metastatic cancer (13%), or death during the hospitalization (4%). AKI was present on admission in 71% of patients and developed after admission in 29%. Overall, 48,202 (22%) died within one year. Between 2013 and 2018, 101,170 (46%) died and 21,116 (9%) experienced a renal readmission. The patient characteristics associated with increased hazard of death included age (HR=1.53 per 10 years, CI 1.52-1.54, p<.001 ), male sex (HR=1.27, CI 1.22-1.32, p<.001), heart failure (HR=1.55, CI 1.53-1.57, p<.001), prior myocardial infarction (HR=1.14, CI 1.11-1.17, p<.001), peripheral vascular disease (HR=1.15, CI 1.13-1.17, p<.001), anemia (HR=1.32, CI 1.30-1.33, p<.001), chronic kidney disease (HR=1.15, CI 1.13-1.17, p<.001), creatinine at time of admission (HR 1.012, CI 1.009-1.015, p<.001) and increase from pre-admission values (HR 1.045, CI 1.041-1.048, p<.001). The same patient characteristics were significant predictors of readmission for a renal indication.

Conclusion

We report factors in AKI survivors that predict long-term mortality and hospital readmission due to renal indication among US Veterans. Cardiovascular diseases were prominent predictors, and AKI follow-up should focus on those with heart disease. Future studies should evaluate the potential benefit in this population from post-hospitalization specialty AKI follow-up.