Kidney Week

Abstract: FR-PO0399

AKI Risk Stratification, Dialysis Risk, and Nephrology Consultation: A 20-Year Cohort Study

Session Information

• AKI: Biomarkers, Diagnostics, and Risk Prediction
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Chang, Yi-Ching, China Medical University Hospital, Taichung, Taichung City, Taiwan

Yi-Ching Chang, MS

• Chiang, Hsiu-Yin, China Medical University Hospital, Taichung, Taichung City, Taiwan

Hsiu-Yin Chiang, MS, PhD

• Chang, David R., China Medical University Hospital, Taichung, Taichung City, Taiwan

David R. Chang, MD

• Yeh, Hung chieh, China Medical University Hospital, Taichung, Taichung City, Taiwan

Hung chieh Yeh, MD

• Kuo, Chin-Chi, China Medical University Hospital, Taichung, Taichung City, Taiwan

Chin-Chi Kuo, MD, PhD, MPH

Background

Inpatient acute kidney injury (AKI) causes substantial morbidity and mortality. We evaluated an algorithm-based risk stratification framework combining AKI stage and baseline eGFR to characterize dialysis risk and nephrology consultation patterns.

Methods

We conducted a retrospective cohort study of inpatients aged 18-90 years at China Medical University Hospital (2003-2022), excluding ESKD, nephrectomy, dialysis, persistent AKD, hospitalization ≥30 days, pregnancy, or death at AKI detection. Baseline serum creatinine (SCr) and AKD were defined using outpatient SCr within 7-180 days pre-admission. Inpatient AKI followed KDIGO SCr criteria. The primary outcome was in-hospital dialysis. Patients were stratified by AKI stage and baseline eGFR into low-, intermediate-, and high-risk groups. Associations with dialysis were evaluated using Cox proportional hazard models with death as a competing risk, adjusting for age, sex, diabetes, and ICU admission.

Results

Of 948968 hospitalizations, 53% were male, median age was 57 years, and AKI occurred in 105867 (11%) visits. Of AKI visits, 50%, 24%, and 26% were classified into the low-, intermediate-, and high-risk groups, respectively. In-hospital dialysis occurred in 1.7%, 4.7%, and 35.4% of the low-, intermediate-, and high-risk groups (Fig 1). Nephrology consultation occurred in 2.6%, 7.5%, and 21.7% of AKI patients, yet remained relatively low for the high-risk group. Hazard ratios for dialysis were 1.8 (low-risk), 2.5–4.9 (intermediate), and 5.4–64.5 (high; Fig 2).

Conclusion

An algorithm-based AKI risk stratification integrating acute stage and baseline eGFR identified marked heterogeneity in dialysis risk in hospitalized patients. Despite high risk, nephrology consultation remained limited in many patients. This systemic approach warrants further evaluation for prioritizing inpatient kidney care.

Funding

• Government Support – Non-U.S.