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Abstract: TH-PO059

Association of Mild-to-Moderate AKI With Decline in eGFRcys vs. eGFRcr 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
  • Zhang, Xiaoming, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Sondheimer, James H., Wayne State University, Detroit, Michigan, United States
  • Ricardo, Ana C., University of Illinois Chicago, Chicago, Illinois, United States
  • McCoy, Ian, University of California San Francisco, San Francisco, California, United States
  • Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
  • Lash, James P., University of Illinois Chicago, Chicago, Illinois, United States
  • Horwitz, Edward J., Case Western Reserve University, Cleveland, Ohio, United States
  • He, Jiang, Tulane University, New Orleans, Louisiana, United States
  • Go, Alan S., Kaiser Permanente, Oakland, California, United States
  • Freedman, Barry I., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Drawz, Paul E., Regents of the University of Minnesota, Minneapolis, Minnesota, United States
  • Chen, Jing, Tulane University, New Orleans, Louisiana, United States
  • Appel, Lawrence J., Johns Hopkins University, Baltimore, Maryland, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background

We reported that after accounting for key potential confounders such as pre-AKI proteinuria and pre-AKI eGFR slope, mild-moderate AKI was not independently associated with an absolute decline in eGFR creatinine (eGFRcr) after AKI. However, analyses based on eGFRcr may underestimate CKD progression due to loss of muscle mass and reduced creatinine generation after hospitalized AKI. Therefore, we examined the decline in cystatin C based eGFR (eGFRcys) after hospitalized AKI.

Methods

In the prospective Chronic Renal Insufficiency Cohort (CRIC), we used multivariable mixed effects models to quantify the independent association between an episode of hospitalized mild-to-moderate AKI with change in absolute eGFR value and change in eGFR slope before vs. after an episode of hospitalized AKI, using eGFRcys (CKD-EPI 2012) and eGFRcr (CKD-EPI 2021).

Results

We included a total of 3,150 participants with mean age of 65 years. Mean baseline eGFRcys and eGFRcr were 51 mL/min/1.73m2 and 52 mL/min/1.73m2, respectively. We observed 612 episodes of AKI among 433 CRIC study participants during a median follow-up of 3.9 years. As shown in the table an episode of AKI at 1.9 years was significantly associated with eGFRcys absolute drop (-2.2 mL/min/1.73 m2, p=0.02), but not eGFRcr (-0.8 mL/min/1.73 m2, p=0.09). There was no detectable change in eGFRcys nor eGFRcr slopes from before to after AKI (see table).

Conclusion

Mild-moderate AKI was associated with a modest drop in absolute eGFR after AKI, but only when using cystatin C as the filtration marker. Our findings suggest that cystatin C should be considered as part of routine post-AKI follow-up to evaluate risk for CKD progression after an episode of AKI.

 Change in eGFR value after each AKI (95% CI)p-valueDifference in eGFR slopes, before and after each AKI episode per year (95% CI)p-value
eGFRcys-2.2 (-3.9, -0.4)0.020.2 (-0.8, 1.1)0.74
eGFRcr-0.8 (-1.7, 0.1)0.090.2 (-0.2, 0.7)0.35

Linear mixed effect models adjusted for clinical center and demographic characteristics (age, sex, and race), time-updated diabetes mellitus, heart failure, systolic blood pressure, receipt of ACEi and ARBs, and proteinuria

Funding

  • NIDDK Support