Abstract: FR-PO0138
Prognostic Effect of Kidney Function Trajectories Following In-Hospital AKI on 90-Day Postdischarge Outcomes: A Multicenter Study
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Liu, Mei, University of Florida Department of Health Outcomes & Biomedical Informatics, Gainesville, Florida, United States
- Xu, Qi, University of Florida Department of Health Outcomes & Biomedical Informatics, Gainesville, Florida, United States
- Chen, Jin, The University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, United States
- Neyra, Javier A., The University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, United States
- Bihorac, Azra, University of Florida College of Medicine, Gainesville, Florida, United States
Background
Changes in kidney function, measured by serum creatinine (SCr), during hospitalization are typically used to guide discharge planning for survivors of hospitalization complicated by acute kidney injury (AKI). However, the impact of specific SCr patterns following AKI onset on post-discharge outcomes remains understudied. We aim to determine if such SCr patterns following AKI could have prognostic relevance for post-discharge outcomes.
Methods
We retrospectively studied adult patients with in-hospital AKI from 10 academic medical centers in the Greater Plains Collaborative (Jan 2009 – Dec 2021) who survived to discharge. Patients were classified based on kidney recovery status at discharge: Full recovery –SCr no longer met KDIGO criteria; Recurrent AKI – SCr briefly improved but elevated again at discharge; Persistent AKI – SCr remained elevated throughout hospitalization; and Undetermined – insufficient post-AKI SCr data. Patients were followed for 90 days for all-cause mortality and major adverse kidney events (MAKE: death, new renal replacement therapy, or ≥25 % eGFR decline from baseline). Statistical analyses included descriptive statistics, subgroup analyses, and multivariable Cox proportional-hazards models.
Results
Among 370,806 eligible in-hospital encounters (mean age 63.9±16.5 years; 51.2% male; 80.4% White; 12.0% chronic kidney disease), AKI status at discharge was: Full recovery 66.8%, Recurrent 4.3%, Persistent 19.6%, Undetermined 9.3%. Overall, 90-day post-discharge mortality was 9.6% and MAKE was 28.1%. Patients with recurrent AKI had the highest 90-day mortality (12.7%) and MAKE (37.8%) (both p < 0.01 vs other groups; one-sided pairwise z-tests). Patients with full AKI recovery had the lowest MAKE rate (25.4%). These trends persisted across AKI severities, 7-day vs 2-day recovery definitions, and after excluding in-hospital RRT cases. Cox models confirmed that, compared to the recurrent AKI group, full AKI recovery, persistent AKI, and undetermined groups all had lower risk for death or MAKE (each HR < 1; p < 0.001).
Conclusion
In-hospital SCr patterns provide important prognostic information beyond discharge SCr alone. Patients with recurrent AKI may represent a high-risk subgroup that may benefit from enhanced post-discharge surveillance.
Funding
- NIDDK Support