Abstract: SA-PO083
Black Patients at Higher Risk of Hospital-Acquired AKI but Lower Risk of Community-Acquired AKI
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Wilson, Clara, Montefiore Medical Center, New York, New York, United States
- April-Sanders, Ayana K., Rutgers School of Public Health, Piscataway, New Jersey, United States
- Neugarten, Joel, Montefiore Medical Center, New York, New York, United States
- Golestaneh, Ladan, Montefiore Medical Center, New York, New York, United States
Background
Previous studies showed higher incidence of acute kidney injury (AKI) among Black patients compared to Whites but failed to adequately characterize this difference. Further detail on racial/ethnic risk of defined types of AKI could inform preventive interventions.
Methods
We describe a cohort of hospitalizations of pediatric and adult patients without prior kidney failure in Montefiore Health System, Bronx, NY, between October 1, 2015 and December 31, 2018. We defined community-acquired AKI(CAAKI) as criteria met by KDIGO in first 48 hours of admission and hospital-acquired AKI(HAAKI) as a 48-hour window rise in creatinine defined by KDIGO occurring after 48 hours of admission and before discharge. We examined unadjusted logistic regression with HAAKI and CAAKI as outcomes, race as exposure, and sequentially adjusted variables accounting for comorbidities and in-hospital risk of mortality. We stratified multivariable adjusted models by in-hospital events according to: 1-severe illness: exacerbation of heart or liver failure, sepsis/shock, cardiac arrest and mechanical ventilation, 2-exposure to nephrotoxic agents: contrast, NSAIDS, diuretics and nephrotoxic chemotherapy, and 3-surgery: occurrence of cardiopulmonary, vascular, orthopedic or neurosurgery; to understand association of race with risk of HAAKI in each scenario.
Results
Of a total 286,383 hospitalizations, 42% were male, 11% were White, 29% were Black, and mean age was 48 years(SD:27). White patients [mean age 63 years(SD: 23)] were older than Black [51 years(SD:25)]. AKI occurred in 56,731 (20%) instances, of which 23,524 (41%) were CAAKI and 33,207 (59%) were HAAKI. In adjusting for age and sex, Black patients were at higher risk for HAAKI [OR 1.21, (CI 1.17-1.27)] and lower risk for CAAKI [0.92, (CI 0.88-0.96)]. Risk for HAAKI attenuated with addition of prior comorbidities, BMI and APR score, but remained significant [OR 1.13, CI (1.08-1.17)]. Black patients had higher odds of HAAKI than White patients when hospitalized with severe illness and underwent major surgery. There was no difference in HAAKI by race with nephrotoxic agent exposure.
Conclusion
Black patients are at higher risk of HAAKI when hospitalizations involve severe illness or major surgery, and at lower risk of CAAKI. Drivers of higher HAAKI risk among severely ill Black patients should be identified.