Kidney Week

Abstract: FR-PO109

Renal Functional Reserve After AKI Predicts Adverse Outcomes at 180 Days

Session Information

• AKI: Outcomes, RRT
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Tiabrat, Vongsatorn, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Vongsatorn Tiabrat,

• Srisawat, Nattachai, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Nattachai Srisawat,

• Lumlertgul, Nuttha, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Nuttha Lumlertgul,

• Praditpornsilpa, Kearkiat, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Kearkiat Praditpornsilpa,

• Eiam-Ong, Somchai, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Somchai Eiam-Ong,

• Avihingsanon, Yingyos, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Yingyos Avihingsanon,

• Peerapornratana, Sadudee, King Chulalongkorn Memorial Hospital, Bangkok, Bangkok, Thailand

Sadudee Peerapornratana,

Background

There is a lack of evidence to guide optimal post-acute kidney injury (AKI) care. Renal functional reserve (RFR) measures the capacity of the kidney to increase glomerular filtration rate (GFR) under various physiologic stresses and is potentially a marker to predict the susceptibility to injury and refine the recovery of kidney function. We aim to examine the association between post-AKI RFR and major adverse kidney events at 180 days after hospital discharge (MAKE₁₈₀) including death, new kidney replacement therapy, and persistent renal dysfunction.

Methods

We enrolled patients with baseline eGFR of >60 mL/min/1.73 m² who survived from moderate to severe AKI with eGFR of >30 mL/min/1.73 m² at hospital discharge between November 2021 to March 2023. RFR was measured by using intravenous amino acid infusion at 1 and 3 months after discharge. Primary end point is the predictive performance of post-AKI RFR for MAKE₁₈₀. Secondary end points include the performance of RFR to predict recurrent AKI and incident chronic kidney disease (CKD) within 6 months.

Results

Among 56 AKI survivors enrolled, median RFR at 1 and 3 months after AKI are significant lower in those who developed MAKE₁₈₀ compared with those who did not (0.86 (4.6-10.6) vs 13.48 (8.6-21.8) mL/min/1.73 m², p=0.002 and -0.69 (-4.67-3.5) vs 17.57 (10.83-38.1) mL/min/1.73 m², p=<0.001, respectively). Patients with MAKE₁₈₀ had RFR declination (negative difference RFR), in contrast, those without MAKE₁₈₀ had RFR improvement over 3 months (-4.39 (-7.42-0.64) vs 14.34 (9.7-22.14) mL/min/1.73 m², p=<0.001). The RFR at 1 and 3 months could predict MAKE₁₈₀ with an AUC of 0.77 (95% CI, 0.62-0.93) with the cut-off value of 8.3 mL/min/1.73 m² (sensitivity 76%, specificity 74%) and AUC of 0.91 (95% CI, 0.81-1) with the cut-off value of 8.6 mL/min/1.73 m² (sensitivity 93%, specificity 83%), respectively. Those who developed incident CKD and recurrent AKI had a significantly lower post-AKI RFR at 1 and 3 months and predicted incident CKD and recurrent AKI with good AUC.

Conclusion

Post-AKI RFR is highly predictive of poor kidney outcomes at 6 months. Larger prospective studies are warranted to explore the association between a reduced RFR and poor outcomes in post-AKI survivors.

Funding

• Government Support – Non-U.S.