Abstract: TH-PO074
Characterising the Natural History of Kidney Recovery after AKI in a Prospective Cohort: Does Timing Matter?
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
- Noble, Rebecca Anne, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
- Selby, Nicholas M., University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
Group or Team Name
- Centre for Kidney Research and Innovation.
Background
Acute kidney injury (AKI) is associated with an increased risk of chronic kidney disease (CKD). It is known that failure of recovery of serum creatinine by 90 days after AKI strongly associates with subsequent CKD, but detailed prospective descriptions of the ‘renal recovery phase’ between AKI and day 90 are lacking. Here we describe outcomes at serial timepoints for a prospective cohort of hospitalised inpatients with AKI in Derby, England.
Methods
Single centre, prospective cohort study of participants will all stages of AKI. Participants characterised in detail, including AKI aetiology, co-morbidities and frailty. Baseline blood and urine samples were obtained at the time of consent, day 30, 60 and 90 with clinical measurements, blood and urine sample collection.
Outcomes of interest: (1) of serum creatinine to within 1.15x baseline, (2) Major Adverse kidney Events (MAKE) a composite of death, renal replacement therapy and persistent renal dysfunction, defined as a 25% or greater drop GFR.
Results
122 participants were recruited. Most patients had more severe AKI (58% stage 3, 23% stage 2, 19% stage 1). M:F (70:52), median age 67.5yrs. Leading cause of AKI was dehydration (n=52, 42.6%). 18.9% (n=23) of participants required renal replacement therapy.
Rates of non-recovery were high. Recovery of renal function (creatinine <1.15xbaseline) was seen in 45% at day 30 (n=49), 50% at day 60 (n=51) and 44% at day 90 (44%). Similar outcomes were observed using MAKE, MAKE30 n =40 (39.6%), MAKE60 n=41 (43.2%), MAKE90 n=41 (46%).
There was no statistically significant difference between the baseline characteristics in the group who did and not recover, including diabetes, 38% vs 50% p=0.47 and duration of AKI, (13 days vs 5 days, p=0.21).
Conclusion
In this cohort of patients with predominantly severe AKI, rates of non-recovery of renal function were high. The lack of difference between the baseline characteristics of the recovered and non-recovered group highlights the difficulty in predicting which patients are going to recover and who will not. Whilst there is some dynamic change over time, most changes are observed by day 30, suggesting the key time for renal repair may be the first 30 days. This is important when considering the timing of future interventional strategies, suggesting that interventions need to be implemented prior to 30 days.