Abstract: PUB050
Risk of Clinical Outcomes Following AKI After Major Surgery
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ohlmeier, Christoph, Bayer AG, Berlin, Germany
- Scott, Charlie, Bayer Public Limited Company, Reading, United Kingdom
- Kong, Sheldon X., Bayer US LLC, Pittsburgh, Pennsylvania, United States
- Schuchhardt, Johannes, MicroDiscovery GmbH, Berlin, Germany
- Bauer, Chris, MicroDiscovery GmbH, Berlin, Germany
- Brinker, Meike Daniela, Bayer AG, Berlin, Germany
- Vaitsiakhovich, Tatsiana, Bayer AG, Berlin, Germany
Background
Risk of acute kidney injury (AKI) is high among patients undergoing major surgery. Limited evidence suggests that AKI episodes increase the risk of subsequent chronic kidney disease, regardless of the AKI cause. Aim of this study was to investigate clinical outcomes in patients with AKI following major surgery as seen in routine clinical care.
Methods
A retrospective cohort study was conducted in a US claims database (Optum Clinformatics Data Mart) using data from Jan 1st, 2009 to Jul 31st, 2020. Adults with an inpatient AKI diagnosis (index date) and a major surgery during the 30 days prior to the AKI were included and followed-up for a maximum of three years until end of enrolment, death or end of study period. Individuals with CKD stage > 3, end-stage kidney disease (ESKD), dialysis or kidney transplant prior to the index AKI were excluded. The primary outcome was CKD stage > 3. Further kidney and cardiovascular outcomes were investigated. The period of 90 days after index AKI was not used for outcomes identification to allow for kidney function recovery. Outcomes were assessed by time-to-first-event analysis.
Results
In total, 41,134 patients were included in the cohort, mean age was 71.3 years (standard deviation: 11.4); 60.9% were male. Coronary artery bypass graft, open heart surgery with extracorporeal blood circulation and hip replacement were most frequent major surgeries prior to AKI. End of follow-up during the 90-day post-AKI period happened in 9,882 (23.0%) patients with death being the main reason (7,518; 76.1%). 31,252 patients were available for time to event analysis.
The 3-year cumulative risk of CKD stage > 3 was 41.2% with the majority of events seen in the first 3 months of outcomes assessment period. The 3-year cumulative risk of all-cause hospitalization, myocardial infarction, stroke, ESKD, dialysis and kidney transplant was 64.2%, 14.4%, 17.7%, 6.6%, 6.2% and 0.2%, respectively.
Conclusion
This study demonstrates that patients experienced AKI are at high risk of subsequent serious clinical outcomes, including CKD stage > 3. The study underlines the high unmet medical need in patients with AKI to prevent CKD, its progression and consequences.
Funding
- Commercial Support – Bayer AG