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Abstract: FR-OR01

AKI Is Associated with Long-Term Decline in Cognitive Function at 3 Years: ASSESS-AKI Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Bhatraju, Pavan K., University of Washington, Seattle, Washington, United States
  • Zelnick, Leila R., University of Washington, Seattle, Washington, United States
  • Siew, Edward D., Vanderbilt University, Nashville, Tennessee, United States
  • Menez, Steven, Johns Hopkins University, Baltimore, Maryland, United States
  • Chinchilli, Vernon M., The Pennsylvania State University, University Park, Pennsylvania, United States
  • Coca, Steven G., Mount Sinai Health System, New York, New York, United States
  • Kaufman, James S., New York University, New York, New York, United States
  • Kimmel, Paul L., National Institutes of Health, Bethesda, Maryland, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Go, Alan S., Kaiser Permanente, Oakland, California, United States
  • Ikizler, Talat Alp, Vanderbilt University, Nashville, Tennessee, United States
  • Himmelfarb, Jonathan, University of Washington, Seattle, Washington, United States
  • Wurfel, Mark M., University of Washington, Seattle, Washington, United States
Background

Cognitive dysfunction is a well-known complication of chronic kidney disease but it is less known whether these long-term adverse events are present in survivors of AKI. We hypothesized that an episode of AKI is associated with poorer cognitive function, mediated, at least in part, by persistent systemic inflammation.

Methods

ASSESS-AKI was a multicenter prospective cohort study that enrolled patients surviving three months after hospitalization with and without AKI who were matched based on demographics, comorbidities and baseline kidney function. A subset of patients underwent cognitive testing using the modified mini-mental test (3MS) at 3, 12 and 36 months. The 3MS is scored on a scale of 0-100. We examined the association of AKI with long-term cognitive testing using mixed linear models accounting for matching and loss to follow-up and assessed the proportion in risk mediated by 3-month systemic inflammatory biomarkers (sTNFR-1, IL-6 and IL-8).

Results

Among 1538 patients enrolled in the parent study (769 with AKI and 769 without), 1465 (95%) completed the 3MS at 3 months. Patients with AKI had lower 3MS scores at 3 months (difference -1.1 (95% CI: -2.0, -0.3) p=0.01) and at 3 years (-1.5 (95% CI: -2.4, -0.7) p<0.01) compared to matched patients without AKI. We also found that a higher proportion of patients with AKI had a clinically meaningful (>5 point) reduction in 3MS scores at 3 years compared to patients without AKI (10% and 5%, p<0.01). In mediation analyses, serum sTNFR-1 mediated 34% (p=0.01) of the AKI related risk for 3MS scores at 3 years, while IL-6 and IL-8 had non-significant proportion mediated.

Conclusion

We found that patients with AKI had significantly worse cognitive function at 3 years after hospitalization. We also found that sTNFR-1 levels appear to mediate a significant proportion of the risk of long-term cognitive impairment.

Funding

  • NIDDK Support