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Kidney Week

Abstract: SA-PO085

Nephrology Follow-Up After Community-Acquired AKI Among US Veterans

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Diamantidis, Clarissa Jonas, 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., 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, Duke University School of Medicine, Durham, North Carolina, United States
  • Wang, Virginia, Duke University School of Medicine, Durham, North Carolina, United States
Background

Community-acquired acute kidney injury (CA-AKI) is a common condition developed outside of the hospital that increases the risk of future hospitalization and death. Little is known about care patterns following CA-AKI, so we evaluated post-AKI nephrology care after an episode of advanced CA-AKI.

Methods

We constructed a retrospective cohort using national VA administrative and lab data to assess the cumulative CA-AKI incidence among active VA primary care users in 2013-2017 with a recorded outpatient serum creatinine (SCr). Veterans with a history of severe kidney disease (≥ Stage 5 or kidney transplant) were excluded. Stage 2 and 3 CA-AKI were defined as ≥ 2.0-2.9-fold or ≥ 3 fold relative increase, respectively, in outpatient SCr or inpatient SCr (≤ 24 hours from admission), from a reference value defined as the preceding outpatient SCr ≤ 12 months prior. A Cox model was used to estimate the association between baseline socio-demographics, comorbidities, care patterns, and CA-AKI event characteristics (stage, setting).

Results

Of the 43,473 veterans with Stage 2 (73%) or Stage 3 (27%) CA-AKI between 2013-2017, mean age was 66.7 years; 5.6% were female, 21.3% Black race, and 6.6% Hispanic ethnicity. Mean eGFR was 70.9 ml/min/1.73m2 and 16.1% had documented CKD. The majority (62.6%) had a history of primary care visit ≤ 90 days prior to the CA-AKI event but few (1%) had a nephrology visit before CA-AKI. Overall, 3.5% of veterans were seen by nephrology ≤ 90 days after their CA-AKI event (3.3% Stage 2, 4.0% Stage 3, 3.8% outpatient CA-AKI, 3.0% inpatient CA-AKI); half (47.7%) of these visits included a diagnosis code for AKI. Veterans with inpatient CA-AKI (HR 0.64 [95% CI 0.57, 0.72]), advancing age (HR 0.88 [0.86, 0.91] per 5 years), and female gender (0.73 [0.56, 0.95]), were less likely to see nephrology within ≤ 90 days after CA-AKI. Those with a CKD (1.58 [1.38, 1.80]), Stage 3 CA-AKI (1.60 [1.43, 1.80]), lower eGFR (1.13 [1.12, 1.15] per 5 unit decrease) or prior nephrology visit ≤ 90 days (3.40 [2.74, 4.22]) had higher likelihood of a follow-up nephrology visit.

Conclusion

Few veterans with Stage 2 or 3 CA-AKI were seen by nephrology in the 90 days after a CA-AKI event. Post-AKI care models prioritizing recognition and nephrology care may improve the adverse outcomes associated with CA-AKI.

Funding

  • NIDDK Support