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Kidney Week

Abstract: PO0234

Clinical Trajectories of AKI in Hospitalized Patients

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ozrazgat-Baslanti, Tezcan, University of Florida, Gainesville, Florida, United States
  • Loftus, Tyler J., University of Florida, Gainesville, Florida, United States
  • Bihorac, Azra, University of Florida, Gainesville, Florida, United States
Background

In surgical sepsis patients, AKI trajectory subgroups have unique physiologic signatures of immunologic and endothelial dysfunction, suggesting potential utility for targeted, therapeutic interventions. It is unknown whether the same phenomena occur among all hospitalized patients. Our objectives are to understand the baseline characteristics of patients who will develop distinct AKI trajectories, determine differences in clinical outcomes, resource use, and long-term survival by AKI trajectory groups defined by persistent kidney injury and renal non-recovery on, and assess the relative importance of AKI severity, duration, and recovery on survival.

Methods

We performed a retrospective study of 156,699 patients admitted to a quaternary care academic hospital between January, 2012 and August, 2019. We used Kidney Disease Improving Global Outcomes and Acute Dialysis Quality Initiative criteria to stage AKI and classify patients as having no AKI, rapidly reversed AKI, persistent AKI with renal recovery, or persistent AKI without renal recovery. Clinical outcomes, resource use, and long-term survival rates were compared among AKI trajectory groups. Cox proportional-hazards regression was used to assess associations between AKI trajectories and time to death while controlling for demographics, Charlson comorbidity score, and provision of mechanical ventilation and ICU admission for two days or greater..

Results

Fifteen percent (54,212/355,678) of the encounters developed AKI. Fifty-eight percent (31,500/54,212) of AKI episodes rapidly reversed within 48 hours; among patients with persistent AKI, two-thirds (14,122/22,712) did not have renal recovery by discharge. One-year mortality was significantly higher among patients with persistent AKI (35%, 7,856/22,712) compared to patients with rapidly reversed AKI (15%, 4,714/31,500) and no AKI (7%, 22,117/301,466). Persistent AKI without renal recovery was associated with approximately five to six fold increased mortality compared to no AKI group, with adjusted hazard ratios of 4.7 and 6.2 for mild and severe AKI.

Conclusion

Among hospitalized patients, persistent AKI and the absence of renal recovery are associated with increased health care resource use and decreased short- and long-term survival. Early identification of patients at increased risk for persistent AKI may facilitate the provision of targeted treatments.

Funding

  • NIDDK Support