Acute Kidney Injury in the Outpatient Setting Associates with Risk of End-Stage Renal Disease and Death in Patients with CKD

• Published in: Scientific reports Vol. 9; no. 1; pp. 17658 - 11
• Main Authors: Yeh, Hung-Chieh, Ting, I-Wen, Huang, Han-Chun, Chiang, Hsiu-Yin, Kuo, Chin-Chi
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 27.11.2019; Nature Publishing Group UK
• Subjects: Acute Kidney Injury - complications; Aged; Algorithms; Creatinine; Creatinine - blood; Death; Disease Progression; End-stage renal disease; Epidermal growth factor receptors; Female; Glomerular Filtration Rate; Humans; Kidney diseases; Kidney Failure, Chronic - etiology; Male; Medicare; Middle Aged; Mortality; Outpatients; Prognosis; Proportional Hazards Models; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; Risk Factors
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-54227-6

Current acute kidney injury (AKI) diagnostic criteria are restricted to the inpatient setting. We proposed a new AKI diagnostic algorithm for the outpatient setting and evaluate whether outpatient AKI (AKI ) modifies the disease course among patients with chronic kidney disease (CKD) enrolled in the national predialysis registry. AKI was detected when a 50% increase in serum creatinine level or 35% decline in eGFR was observed in the 180-day period prior to enrollment in the predialysis care program. Outcomes were progression to end-stage renal disease (ESRD) and all-cause mortality. Association analyses were performed using multiple Cox regression and coarsened exact matching (CEM) analysis. Among 6,046 patients, 31.5% (1,905 patients) had developed AKI within the 180-day period before enrollment. The adjusted hazard ratios of the 1-year and overall risk of ESRD among patients with preceding AKI compared with those without AKI were 2.61 (95% CI: 2.15-3.18) and 1.97 (1.72-2.26), respectively. For 1-year and overall risk of all-cause mortality, patients with AKI had respectively a 141% (95% CI: 89-209%) and 84% (56-117%) higher risk than those without AKI . This statistical inference remained robust in CEM analysis. We also discovered a complete reversal in the eGFR slope before and after the AKI from -10.61 ± 0.32 to 0.25 ± 0.30 mL/min/1.73 m per year; however, the loss of kidney function is not recovered. The new AKI diagnostic algorithm provides prognostic insight in patients with CKD.