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Kidney Week

Abstract: TH-OR06

Readmission and Mortality After AKI Hospitalization

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Schulman, Ivonne Hernandez, DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Ngo, Duc Anh, DLH Corporation, Silver Spring, Maryland, United States
  • Chan, Kevin L., DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Abbott, Kevin C., DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Wilkins, Kenneth J., DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Sayer, Bryan, DLH Corporation, Silver Spring, Maryland, United States
  • Eggers, Paul, DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Norton, Jenna M., DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Shah, Neha, DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Mendley, Susan R., DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Parsa, Afshin, DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Der, Jane S., DLH Corporation, Silver Spring, Maryland, United States
  • Star, Robert A., DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
  • Kimmel, Paul L., DKUHD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States
Background

Acute kidney injury (AKI) associates with high morbidity/mortality, but we lack robust data to quantify short to long-term real-world outcomes after an AKI hospitalization. We derived a synthetic retrospective cohort of hospitalized AKI subjects from Optum Clinformatics, a large claims database, to quantify mortality and all-cause/selected rehospitalizations 90 days and 1 year after an AKI event.

Methods

All AKI hospitalizations between 1/2007 and 9/2020 who had >2 years of continuous enrollment free of AKI hospitalization were identified (n=594,509) from the Optum database and propensity score matched to 594,509 control subjects who were hospitalized for a non-AKI cause.

Results

Mean age (SD) of the AKI cohort was 74.1 (13.1) years and 47.6% were women, 73.7% were white, 14.1% were Black, 9.7% were Hispanic, and 2.5% were Asian, which was similar to the matched non-AKI cohort. 55.9% of AKI and 26.5% of matched non-AKI group were hospitalized in the 2 years before the index admission. 50.3% of AKI group had CKD and 34.9% had heart failure, similar to the matched non-AKI group. One-year unadjusted cumulative incidence of all-cause rehospitalization was higher in AKI vs matched non-AKI patients in the presence and absence of pre-existing CKD (p<0.01). Adjusting for baseline characteristics, AKI was associated with a higher rate of hospital readmission from any cause [Hazard ratio (HR) 1.77; 95%CI 1.75-1.80; death as competing risk], heart failure (HR 3.16; 95%CI 3.00-3.32), pneumonia (HR 1.64; 95%CI 1.54-1.75), sepsis (HR 3.06; 95%CI 2.92-3.21), and ESRD (HR 7.88; 95%CI 1.88-33.07) in the 90 days after discharge compared to the non-AKI group. Both crude and adjusted mortality rates were higher in the AKI group compared to the non-AKI at 90 (HR 3.04; 95%CI 2.98- 3.09) and 365 days (HR 2.39; 95%CI 2.36-2.42) and persisted when the groups were stratified by CKD status (vs without, p<0.01).

Conclusion

AKI hospitalization substantially increases the risk for subsequent death, hospitalization, heart failure, pneumonia, and sepsis compared to non-AKI hospitalization. These findings show novel interventions that mitigate the high burden of morbidity and mortality after an AKI hospitalization event are needed.

Funding

  • Other NIH Support