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Abstract: FR-PO064

Outcomes Following Community-Acquired AKI: A National Study of US Veterans

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Wang, Virginia, Duke University School of Medicine, Durham, North Carolina, United States
  • Zepel, Lindsay, Duke University School of Medicine, Durham, North Carolina, United States
  • Maciejewski, Matthew L., Durham VA Medical Center, Durham, North Carolina, United States
  • Chang, Erin Burks, Duke University School of Medicine, Durham, North Carolina, United States
  • Brookhart, M. Alan, Duke University School of Medicine, Durham, North Carolina, United States
  • Bowling, C. Barrett, Durham VA Medical Center, Durham, North Carolina, United States
  • Diamantidis, Clarissa Jonas, Duke University School of Medicine, Durham, North Carolina, United States
Background

Community-acquired acute kidney injury (CA-AKI) develops outside of the hospital and is the most common form of AKI. Due to limited availability of outpatient lab and integrated health data, CA-AKI outcomes are poorly studied. This study leveraged national data to examine associations between incident CA-AKI and subsequent hospitalization and mortality.

Methods

We constructed a retrospective cohort of active primary care patients in the Veterans Health Administration (VA) in 2013-2017, excluding Veterans with no recorded outpatient serum creatinine (SCr) and those with a history of severe kidney disease (≥ Stage 5 or kidney transplant). CA-AKI was defined as ≥1.5-fold relative increase in outpatient SCr or inpatient SCr (≤24 hours from admission), from a reference value defined as the preceding outpatient SCr ≤12 months prior. We compared outcomes in Medicare and VA databases from a pooled cohort of patients with CA-AKI and a 5% random sample without observed CA-AKI. Cox models estimated associations between CA-AKI and 2-year all-cause hospitalization and mortality, adjusting for patient characteristics.

Results

With an annual cumulative CA-AKI incidence of approximately 2% in 2013-2017, the analytic cohort consisted of all 220,777 Veterans with CA-AKI and 492,539 controls with no CA-AKI. Those with CA-AKI had a higher hazard of 2-year all-cause hospitalization (hazard ratio [HR]=1.89, 95% confidence interval [CI] 1.87, 1.90) and mortality (HR=2.72, 95% CI 2.67, 2.77) compared to those without CA-AKI. These risks increased with greater CA-AKI severity (hospitalization: Stage 1 HR=1.80, 95% CI 1.78, 1.81; Stage 2 HR=2.23, 95% CI 2.19, 2.27; Stage 3 HR=2.68, 95% CI 2.60, 2.76; mortality: Stage 1 HR=2.50, 95% CI 2.45, 2.54; Stage 2 HR=3.45, 95% CI 3.35, 3.55; Stage 3 HR=4.57, 95% CI 4.38, 4.76). Compared with no CA-AKI, CA-AKI within 24 hours of hospital admission was associated with greater hazard of mortality (HR=3.81, 95% CI 3.72, 3.90) than among those with CA-AKI in the outpatient setting (HR=2.42, 95% CI 2.37, 2.46).

Conclusion

In a national cohort of Veterans, CA-AKI was associated with an approximately two-fold increased risk of hospitalization and mortality. Strategies to improve identification and follow-up management is critical to mitigate adverse outcomes of CA-AKI.

Funding

  • NIDDK Support