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Abstract: FR-PO065

AKI and ESRD Progression in Older Adult Veterans With Advanced CKD

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Medunjanin, Danira, Medical University of South Carolina, Charleston, South Carolina, United States
  • Wolf, Bethany, Medical University of South Carolina, Charleston, South Carolina, United States
  • Pisoni, Roberto, Medical University of South Carolina, Charleston, South Carolina, United States
  • Taber, David J., Medical University of South Carolina, Charleston, South Carolina, United States
  • Pearce, John L., Medical University of South Carolina, Charleston, South Carolina, United States
  • Hunt, Kelly J., Medical University of South Carolina, Charleston, South Carolina, United States
Background

Those ≥65 years represent the largest growing age category in the US. Advanced age is a major risk factor for the development of CKD, which has high heterogeneity in disease progression. Hospitalization rates for AKI are increasing, especially amongst older adults who are at particular risk given their high comorbidity burden and susceptibility to nephrotoxins. Previous AKI epidemiologic analyses have focused on hospitalized populations which may bias results towards sicker populations; particularly when results are extrapolated to ambulatory CKD populations.

Methods

This was a national longitudinal cohort study which performed competing risk regression analysis on 24,133 older Veterans (≥65 years), with incident CKD stage 4 from 2011-2013 to determine the association between AKI and progression to ESRD while evaluating age as an effect modifier. The following covariates based on a priori selection were adjusted for: AKI severity and history, age, sex, race-ethnicity, service-connected disability, Elixhauser comorbidity burden, NSAIDs, ACE inhibitors, diuretics, rural residence, and driving distance to nearest primary care. Veterans were followed until December 31, 2016, or death. AKI was defined according to the modified KDIGO AKIN definition. Due to the time constraint in defining AKI (≤ 7 days), we were limited to inpatient labs. Most studies of hospitalized patients with AKI assign a baseline SCr at the time of admission which may not reflect stable levels of kidney function. Because the VA is the largest integrated health care system in the US, we can access outpatient SCr labs prior to hospitalization to determine an appropriate baseline kidney function. ESRD was defined by entry into the USRDS registry. Death was considered the competing risk.

Results

Adjusted modeling demonstrated AKI was independently associated with a 1.9-fold increased risk [HR: 1.91 95% CI: 1.64-2.23)] of ESRD progression. Age was not an effect modifier of this relationship (p-value=0.08). Though non-significant, AKI was associated with a 6% increase [HR: 1.06 (95% CI: 0.96-1.16) in death.

Conclusion

Regardless of AKI status, death was far more frequent than ESRD in this population (51.1% vs. 14.5%). Despite this, our national cohort study showed that AKI was a substantial and independent risk factor for the development of ESRD in older Veterans with advanced CKD.

Funding

  • Veterans Affairs Support