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Abstract: SA-OR12

Association of Mild-to-Moderate AKI with CKD Progression Among Individuals with CKD: The CRIC Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
  • Drawz, Paul E., Regents of the University of Minnesota, Minneapolis, Minnesota, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Horwitz, Edward J., The MetroHealth System, Cleveland, Ohio, United States
  • Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • He, Jiang, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Appel, Lawrence J., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Go, Alan S., Kaiser Permanente, Oakland, California, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background

Observational studies have suggested that even mild episodes of AKI have a large effect on accelerating CKD progression (EJ See et al 2019;95:160-172). These seem inconsistent with clinical trials in which reducing AKI rate did not translate into reducing CKD risk (AX Garg et al JAMA 2014: 311:2191-8, SG Coca et al JASN 2016; 27: 2529-42). These differences may be due to incomplete control of important confounders such as proteinuria since proteinuria is both a strong risk factor for development of AKI and CKD progression.

Methods

To better address potential residual confounding, including confounding by pre-AKI proteinuria and pre-AKI eGFR slope, we quantified the independent association between an episode of mild-to-moderate AKI (identified using inpatient SCr measurements and staged using KDIGO guidelines) on eGFR trajectory (defined using outpatient research protocol measurements) in the prospective Chronic Renal Insufficiency Cohort (CRIC).

Results

Mean age of the 3150 CRIC participants included was 65 years, 44% were female, and 43% self-identified as Black. Mean baseline eGFR was 50 mL/min/1.73m2, median urine protein-Cr ratio was 0.1g/g, and 54% had diabetes. 433 participants experienced at least one episode of AKI (68% stage 1; 24% stage 2). In linear mixed effects models, after controlling for demographics, pre-AKI proteinuria, pre-AKI eGFR slope, and time-updated diabetes mellitus, heart failure, SBP, and receipt of ACE-I/ARBs, an episode of AKI was not significantly associated with eGFR change (difference in mean eGFR at year 1 = -0.7 mL/min/1.73 m2, 95% CI -2.7 to 1.2 mL/min/1.73 m2 95%, p=0.46). There was no detectable change in eGFR slope from before to after AKI (difference in eGFR slope = 0.1 mL/min/1.73 m2 per year) (p=0.82 and 95% CI -0.7 to 0.8 mL/min/1.73 m2 per year).

Conclusion

Prior observational studies showing an association between mild-to-moderate AKI and CKD progression may be exaggerated due to residual confounding. After accounting for key potential confounders hitherto not considered in published analyses, mild-moderate AKI was not independently associated with an absolute drop in eGFR nor eGFR slope after AKI.

Funding

  • NIDDK Support