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Kidney Week

Abstract: PO0231

Risk Factors for Long-Term Mortality Following AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Griffin, Benjamin R., Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Wachsmuth, Jason, Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Yamada, Masaaki, Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Sambharia, Meenakshi, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Girotra, Saket R., Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Perencevich, Eli, Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Reisinger, Heather, Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Sarrazin, Mary Vaughan, Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background

Acute kidney injury (AKI) occurs in over 20% of hospitalized patients and is associated with increased long-term mortality. The purpose of this study is to identify risk factors for 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 outcome was mortality, with follow-up ranging from 2-7 years. Over 50 variables were considered for inclusion in the final model, including demographics, comorbidities, and laboratory data. Bootstrap modeling was used to determine the outcomes of one hundred stepwise regressions using random sampling with replacement, and those included in more than 60 of the 100 models were evaluated in a final model using Cox regression. Given that over a quarter of post-AKI mortality is due to cardiac disease, separate models were constructed for patients with and without pre-existing cardiac disease at baseline.

Results

A total of 241,781 Veterans with AKI were included. There were 47,390 deaths out of 139,144 (34%) in the non-cardiac group, and 54,384 deaths out of 102,637 (53%) in the cardiac disease group. The final Cox regression models for each population are given in Table 1. Harrell’s Concordance values were 0.67 and 0.66, respectively. Cardiac comorbidities were major predictors of mortality in the cardiac group. Notably, kidney metrics such as admission creatinine and discharge creatinine were not selected for inclusion, and AKI stage was not a strong predictor in the non-cardiac model where it was included.

Conclusion

We report factors in AKI survivors that predict long-term mortality among US Veterans. Mortality was significantly higher in the cardiovascular disease group, and cardiovascular history was a major risk factor. Variables related to creatinine values or AKI stage were not strong predictors of mortality.