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Kidney Week

Abstract: SA-PO092

Preadmission Veterans Aging Cohort Study Index Is Associated with AKI in Hospitalized People with HIV

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Fisher, Molly, Albert Einstein College of Medicine, Bronx, New York, United States
  • Hanna, David B., Albert Einstein College of Medicine, Bronx, New York, United States
  • Fazzari, Melissa, Albert Einstein College of Medicine, Bronx, New York, United States
  • Felsen, Uriel R., Albert Einstein College of Medicine, Bronx, New York, United States
  • Wyatt, Christina M., Duke Medicine, Durham, North Carolina, United States
  • Abramowitz, Matthew K., Albert Einstein College of Medicine, Bronx, New York, United States
  • Ross, Michael J., Albert Einstein College of Medicine, Bronx, New York, United States
Background

People with HIV (PWH) are at increased risk for acute kidney injury (AKI) and its sequelae. Numerous biomarkers have been shown to predict AKI but most are not routinely measured in practice. The Veterans Aging Cohort Study (VACS) index is a score based on age, CD4 count, HIV viral load, hemoglobin, eGFR, hepatitis C virus (HCV) antibody, platelets, AST and ALT. The VACS index predicts a number of outcomes and is highly correlated with markers of inflammation, including TNF alpha and IL-6 which have been shown to be predictive of AKI. We therefore hypothesized that preadmission VACS index would be associated with AKI.

Methods

We performed a cohort study of 1,186 PWH hospitalized in a New York City health system between 2010-2019. Outpatient laboratory values prior and closest to admission (7-365 days) were used to create the VACS index. The VACS index was divided into quartiles (<22, >22 to 34, >34 to 55, >55). AKI was defined by KDIGO criteria. Multivariable Cox regression adjusting for sociodemographics, diabetes and intensive care unit admission was used to determine the association between VACS quartile and risk of AKI, treating the competing risks of death and discharge as censoring events.

Results

Median age was 53 years (IQR 43, 60), 516 (43.5%) were women, 500 (42.2%) were Hispanic, 522 (44%) were non-Hispanic Black and 195 (23.1%) were coinfected with HCV. Median CD4 count was 465 cells/mm3 (IQR 201, 714) and 65% were virally suppressed (<200 copies/mL). The unadjusted AKI incidence was higher with increasing VACS quartile: 39 (10.7%) in Q1, 41 (18.6%) in Q2, 61 (28.1%) in Q3 and 107 (60.7%) in Q4. Compared to those in the lowest VACS quartile, the adjusted relative hazard (aHR) of AKI was 1.50 times higher (95% CI 0.96, 2.33; p=0.07) in Q2, 1.93 times higher (95% CI 1.28, 2.91) p=0.002) in Q3 and 3.23 times higher (95% CI 2.21, 4.74; p<0.0001) in Q4.

Conclusion

Preadmission VACS index is independently associated with AKI. The VACS index may allow for timely identification of PWH at risk for AKI and initiation of preventative strategies including intravenous fluids, avoidance of nephrotoxic medications and careful drug dosing. Our findings should be replicated in a larger cohort and future studies should evaluate its ability to predict severe AKI and nonrecovery from AKI.

Funding

  • Other NIH Support