Kidney Week

Abstract: FR-PO071

Acute Kidney Disease Staging Based on Estimated Glomerular Filtration Rate Predicts Outcomes Better than Staging Based on Serum Creatinine in Patients with Dialysis-Requiring AKI

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Pan, Szu-Yu, National Taiwan University Hospital, Taipei, Taiwan

Szu-Yu Pan, MD, PhD

• Teng, Naichi, National Health Research Institutes, Zhunan, Taiwan

Naichi Teng, MS

• Chen, Likwang, National Health Research Institutes, Zhunan, Taiwan

Likwang Chen

• Wu, Vincent, National Taiwan University Hospital, Taipei, Taiwan

Vincent Wu, MD, PhD

Background

The comparative performance of two staging systems for acute kidney disease (AKD), designated AKD_eGFR and AKD_sCr, remains uncertain. Our objective is to assess the predictive ability of these staging systems concerning outcomes.

Methods

This population-based retrospective observational cohort study identified 71,289 hospitalized patients with acute kidney injury requiring dialysis between July 1, 2015, and June 30, 2022, in the Taiwan National Health Insurance Research Database. AKD stages were defined according to the ADQI 16 Workgroup (AKD_sCr) and 2021 KDIGO Consensus (AKD_eGFR). Cox proportional hazard models were constructed to examine associations between AKD stages and outcomes including mortality and sustained renal recovery.

Results

The AKD_eGFR staging system predicted both outcomes better than the AKD_sCr staging system (Figure 1). Hazard ratios and 95% confidence intervals for mortality across increasing AKD_eGFR stages were 1.27 (1.18 - 1.36), 1.70 (1.59 - 1.82), 2.49 (2.35 - 2.64), 2.96 (2.78 - 3.15), and 5.22 (5.02 - 5.43). Conversely, within the AKD_sCr staging system, hazard ratios and 95% confidence intervals for mortality across ascending stages were 1.00 (0.93 - 1.07), 1.00 (0.91 - 1.10), 0.93 (0.81 - 1.07), and 3.37 (3.27 - 3.46). Subgroup and sensitivity analyses yielded consistent results.

Conclusion

The AKD_eGFR staging system performs better than the AKD_sCr staging system in patients with acute kidney injury requiring dialysis regarding all-cause mortality and kidney recovery.

Figure 1. The adjusted hazard ratios (HRs) for mortality (Figure 1a) and sustained renal recovery (Figure 1b) across AKD stages in the AKD_eGFR (up) and AKD_sCr (down) staging systems were shown. AKD stage 0 served as the reference. Dots and error bars represented the point estimates and the 95% confidence intervals of the HRs.

Funding

• Government Support – Non-U.S.