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Kidney Week

Abstract: SA-PO058

Social Determinants of Health and AKI During Hospitalization

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Takeuchi, Tomonori, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Ghazi, Lama, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Baker, Elizabeth H., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Oates, Gabriela R., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Juarez, Lucia D., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Nassel, Ariann F., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Rahman, Akm Fazlur, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Siew, Edward D., Vanderbilt University, Nashville, Tennessee, United States
  • Gutierrez, Orlando M., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

AKI is highly prevalent in hospitalized patients. Social determinants of health (SDOH) have been understudied as AKI risk factors. Our goal was to determine whether SDOH impacts AKI risk and AKI recovery during hospitalization.

Methods

Retrospective cohort study of patients aged ≥18 years without end-stage kidney disease admitted to the hospital from 10/2014 to 9/2017. Outcome measures were (1) Incident AKI defined by the KDIGO SCr-criteria and (2) AKI recovery defined as last SCr before discharge <25% or <0.3 mg/dL from baseline and not receiving dialysis within 72 h of discharge in patients who survived the hospitalization. We linked geocoded patient addresses at the index hospitalization to the corresponding U.S. Census tracts and block groups and the following SDOH measures: (1) neighborhood socioeconomic status measured with Area Deprivation Index (ADI) scores, (2) food access measured with Low Income Low access (LILA) scores, (3) rurality measured with Rural Urban Commuting Area (RUCA) scores, and (4) residential segregation measured with dissimilarity and isolation scores. Multivariable logistic regression was used to quantify the association between SDOH measures, each independently, and AKI development and recovery.

Results

Out of 26,769 patients, 6,976 (26%) developed AKI during hospitalization. Compared to those who did not develop AKI, patients who developed AKI were older (60 [47,71] vs 57 [47,68] years), more likely to be men (55 vs 50%), and more likely to be Black (38 vs 33%). Patients who lived in the highest tertile for ADI (most disadvantaged) were more likely to develop AKI during hospitalization even after adjustment (Table). In the fully adjusted model, Patients who lived in the highest tertile of ADI and in a LILA tract were less likely to have AKI recovery at the time of discharge (OR 0.85 [0.72,0.99] and OR 0.86 [0.74,0.99]). Rurality and residential segregation were not associated with incident AKI or AKI recovery.

Conclusion

Patients in the highest tertile of neighborhood disadvantage were more likely to develop AKI and less likely to recover.

Funding

  • NIDDK Support