Kidney Week

Abstract: TH-PO072

Is AKI an Independent Risk Factor for Subsequently Decreased Kidney Function after Accounting for Pre-AKI Proteinuria and Pre-AKI eGFR Slope?

Session Information

• AKI: Clinical, Outcomes, and Trials - Epidemiology and Pathophysiology
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Prado, Victor E., University of California San Francisco School of Medicine, San Francisco, California, United States

Victor E. Prado, MD

• McCoy, Ian Ellis, University of California San Francisco School of Medicine, San Francisco, California, United States

Ian Ellis McCoy, MD, MS, FASN

• Zhang, Yue, The Pennsylvania State University, University Park, Pennsylvania, United States

Yue Zhang, MPH

• Liu, Kathleen D., University of California San Francisco School of Medicine, San Francisco, California, United States

Kathleen D. Liu, MD, PhD, FASN

• Muiru, Anthony N., University of California San Francisco School of Medicine, San Francisco, California, United States

Anthony N. Muiru, MD, MPH

• Chinchilli, Vernon M., The Pennsylvania State University, University Park, Pennsylvania, United States

Vernon M. Chinchilli, PhD

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca, DO, MS

• Go, Alan S., Kaiser Permanente, Oakland, California, United States

Alan S. Go, MD

• Himmelfarb, Jonathan, University of Washington, Seattle, Washington, United States

Jonathan Himmelfarb, MD, FASN

• Kaufman, James S., New York University, New York, New York, United States

James S. Kaufman, MD

• Kimmel, Paul L., National Institutes of Health, Bethesda, Maryland, United States

Paul L. Kimmel, MD, FASN

• Ikizler, Talat Alp, Vanderbilt University, Nashville, Tennessee, United States

Talat Alp Ikizler, MD, FASN

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Siew, Edward D., Vanderbilt University, Nashville, Tennessee, United States

Edward D. Siew, MD, MS, MSc

• Wurfel, Mark M., University of Washington, Seattle, Washington, United States

Mark M. Wurfel, MD, PhD

• Hsu, Chi-yuan, University of California San Francisco School of Medicine, San Francisco, California, United States

Chi-yuan Hsu, MD, MS, MSc, FASN

Background

A recent Chronic Renal Insufficiency Cohort (CRIC) analysis showed that after accounting for pre-AKI eGFR slope, pre-AKI proteinuria and other confounders, an episode of mild to moderate AKI was not an independent risk factor for changes in subsequent eGFR or eGFR slope (Ann Intern Med. 2023;176:961-8). We sought to confirm or refute these findings leveraging comparable data from the ASsessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) study in which participants also underwent yearly study protocol driven measurements of eGFRcr (CKD-EPI 2021), eGFRcys (CKD-EPI 2012), urine protein-Cr ratio (uPCR) and had capture of interim AKI episodes by inpatient SCr values.

Methods

Hospitalized AKI was defined as ≥50% difference in nadir to peak inpatient SCr. Linear mixed-effects regression models were used to examine whether AKI was associated with abrupt loss of eGFR (i.e. incomplete recovery) or steeper eGFR slope after AKI.

Results

We analyzed all 1603 enrolled ASSESS-AKI study participants (37.6% female,12.5% non-Hispanic Black). At baseline, mean age was 65 (SD±13) years, eGFRcr 72 (±26) mL/min/1.73 m², eGFRcys 56 (±27) mL/min/1.73 m² and median uPCR 0.13 g/g [IQR0.08 to 0.25]. 41% had diabetes mellitus, and 21% had a history of heart failure. During median follow-up of 4.6 years, 698 AKI episodes (83.1% stage 1 in severity) were observed among 407 participants. In the fully adjusted model, AKI was independently associated with a -2.22 mL/min/1.73m² abrupt loss of eGFRcr but not with steeper subsequent eGFRcr slope. Similar results were seen with eGFRcys (Table).

Conclusion

Contrary to what was observed in CRIC, among ASSESS-AKI study participants, an AKI event was associated with a loss of kidney function (i.e. incomplete recovery), even after accounting for pre-AKI proteinuria and pre-AKI eGFR slope. However, the slope of eGFR decline did not worsen after AKI.

Table

*Adjusted for demographics, baseline eGFR, time-updated comorbidities, uPCR, SBP, ACEI/ARB use

Funding

• NIDDK Support