Kidney Week

Abstract: FR-PO120

Early Clinical Indicators of ESKD Transition or Kidney Recovery in Patients with AKI on Dialysis

Session Information

• AKI: Diagnosis and Outcomes
  October 25, 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

• Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States

Scott Sibbel, PhD

• Ryan, Claire, Davita Clinical Research, Minneapolis, Minnesota, United States

Claire Ryan, MS

• Colson, Carey, Davita Clinical Research, Minneapolis, Minnesota, United States

Carey Colson

• Gibson, Cicely Nicole, DaVita Inc, Denver, Colorado, United States

Cicely Nicole Gibson, RN

• Goykhman, Irina, DaVita Inc, Denver, Colorado, United States

Irina Goykhman

• Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States

Francesca Tentori, MD, MS

• Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli, MD

Background

Previous studies reporting factors impacting renal recovery in acute kidney injury (AKI) patients were limited to the inpatient setting. With the 2017 changes to Medicare Reimbursement, patients with AKI that dialyze in the outpatient setting (AKI-D) are increasing in number. We sought to investigate which early indicators in AKI-D patients, those preceding or captured during the hospitalization, predict the likelihood of transition to ESKD or recovery.

Methods

For this analysis, we used the Optum® de-identified Integrated Claims-Clinical Dataset that links administrative claims and clinical data from providers across the continuum of care.¹ Patients included in the study (n=760) were >18 years old, had a claim from 2017-2023 for in-hospital dialysis and an AKI diagnosis and began outpatient dialysis within 3 days of discharge; patients with a previous dialysis treatment or ESKD diagnosis were excluded. We employed a case control study among those that recovered vs. those yet to have recovered.

Results

Those that recovered were younger (63 vs. 68 years old), were more likely to have AKI attributed to acute tubular necrosis (ATN) and/or sepsis during hospitalization; and less likely to have prior diagnoses of CKD 4/5 or cardiovascular disease (PVD, CAD, CVD, and CHF). A heuristic developed from the integrated data set segregates patients into two groups: high likelihood of recovery (64%) vs. a low/medium likelihood of recovery (30% and 45%, respectively).

Conclusion

When considered together, these attributes of patient’s medical history and diagnoses can be used to reasonably predict the AKI patients that will recover in the outpatient setting. However, better data collection strategies, testing, and validation are necessary to ensure validity.


¹ Optum’s de-identified Integrated Claims-Clinical dataset (2007-2021)