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Kidney Week

Abstract: TH-PO045

Urea Reduction in AKI and Mortality

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Chavez, Jonathan, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Navarro Blackaller, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico
  • Maggiani, Pablo, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Barajas, José David González, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Venegas, Miguel Ángel Pérez, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Medina, Ramon, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Alcantar Vallin, Maria de la luz, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Oseguera Gonzalez, Alexa Nicole, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Murguía Soto, César, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Renoirte, Karina, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • Garcia-Garcia, Guillermo, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
Background

Urea is a toxin present in AKI. It is reasonable to think that its decrease could be associated with better clinical evolution. We explore the association between urea reduction and mortality in patients with AKI

Methods

In this prospective cohort in AKI patients . We create 4 groups of urea reduction (UrR) by their percentage decrease magnitude: 0, 1-25, 26-50 and >50. The objectives was to assess the association of UrR and mortality within 10 days of admission; find the characteristics of patients with UrR >50% and identify which KRT modality (hemodialysis, peritoneal dialysis and conservative) achieved this goal

Results

A total of 651 AKI patients were included. AKI stage 3 was present in 58.5%, sepsis in 45.9%, the mean urea value was 154 mg/dL, kidney replacement therapy (KRT) started in 32.4%, and 18.9% died. 50% did not reduce urea (UrR 0%). A trend to decrease risk of dead was observed with the magnitude of UrR. The best survival (94.3%) was observed in those with UrR >50%, and worst (72.1%) in those with UrR 0%. After adjusting for confounders, 10-day hospital mortality was higher in groups that did not achieve a UrR of at least 25% with an OR of 1.20. Subgroups of patients who achieved UrR >50% were those with uremic and obstructive nephropathy.

Conclusion

In our prospective cohort 50% with AKI did not reduce urea, and this was associated with an increased risk of death. Achieving UrR of at least 25% decreased the risk, and a greater magnitude of UrR with any treatment was associated with better survival.

Urea reduction in AKI and mortality risk

Subgroup analysis of patients with urea reduction >50% with kidney replacement therapy, conservative managment and mortality