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Abstract: TH-PO057

Pre-Hospitalization Characteristics Confound AKI Associations With Cardiovascular Outcomes: Findings From the CRIC Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • McCoy, Ian, 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
  • Diamantidis, Clarissa Jonas, Duke University School of Medicine, Durham, North Carolina, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Go, Alan S., Kaiser Permanente, Oakland, California, 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
  • Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Horwitz, Edward J., Case Western Reserve University, Cleveland, Ohio, United States
  • He, Jiang, Tulane University, New Orleans, Louisiana, United States
  • Chen, Jing, Tulane University, New Orleans, Louisiana, United States
  • Lash, James P., University of Illinois Chicago College of Medicine, Chicago, Illinois, United States
  • Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background

AKI during hospitalization has been associated with increased risks of cardiovascular events, but these associations may be confounded by differences in pre-hospitalization characteristics, including the pre-hospitalization rate of kidney function decline and pre-hospitalization proteinuria level.

Methods

Among 1,630 participants hospitalized in 2013-2019 in the Chronic Renal Insufficiency Cohort (CRIC) study who survived until the next post-hospitalization study visit, we examined associations between AKI and subsequent cardiovascular outcomes: time to first heart failure hospitalization and time to first atherosclerotic event (ASCVD: encompassing myocardial infarction, ischemic stroke, or peripheral arterial disease). AKI-outcome associations (adjusted for demographics, BMI, diabetes mellitus, coronary artery disease, heart failure, smoking status, dyslipidemia, family history of coronary disease) were assessed using cause-specific hazard models before and after adjusting for pre-hospitalization variables (eGFR, eGFR slope, proteinuria, blood pressure, and antihypertensive use).

Results

As compared to patients who did not experience AKI (n=1317), patients who experienced AKI during their hospitalizations (n=313) had not only worse kidney function pre-hospitalization (eGFR 44 vs 50 ml/min/1.73m2) but also faster chronic loss of kidney function pre-hospitalization (eGFR slope -0.68 vs -0.43 ml/min/1.73m2/yr), and more proteinuria pre-hospitalization (UPCR 0.24 vs 0.15 g/g); they also had higher pre-hospitalization systolic blood pressure (130 vs 127 mmHg) despite more antihypertensive medications (p<0.001 for all comparisons). AKI associations with heart failure and ASCVD were attenuated and lost significance after adjustment for pre-AKI variables.

Conclusion

Pre-hospitalization variables including eGFR slope and proteinuria confound associations between AKI and cardiovascular outcomes.

Adjusted hazard ratios (95% confidence intervals) of AKI for cardiovascular outcomes
ModelHeart Failure (HF)ASCVD (MI, Stroke, PAD)
AKI (adjusted as per methods section)1.51 (1.13-2.03)1.44 (1.03-2.02)
AKI (additionally adjusted for pre-hospitalization variables)1.30 (0.97-1.75)1.27 (0.90-1.80)

MI: myocardial infarction; PAD: peripheral arterial disease

Funding

  • NIDDK Support