Abstract: TH-PO050
Impact of AKI on Prognosis of Hospitalized Patients with Malignancy-Related Ascites
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention - 1
October 24, 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
- Sohail, Mohammad Ahsan, Cleveland Clinic, Cleveland, Ohio, United States
- Calle, Juan C., Cleveland Clinic, Cleveland, Ohio, United States
Background
Malignant diseases can cause ascites by a variety of mechanisms, including peritoneal carcinomatosis and hepatic metastases leading to portal hypertension. Acute kidney injury (AKI) is frequently observed in hospitalized patients with malignancy-related ascites (MRA) and is associated with increased length of stay and hospital costs. Although there is robust data to support that AKI in cirrhotic patients with ascites is associated with increased mortality, to our knowledge, the prognosis of patients with MRA and AKI has not yet been described in the literature. Our study evaluates the impact of AKI severity and progression on in-hospital mortality in patients with MRA.
Methods
We conducted a retrospective cohort study of all hospitalized patients at the Cleveland Clinic from January 2012 to December 2022 with MRA who fulfilled AKI criteria at the time of admission. Baseline kidney function was defined by the serum creatinine and eGFR obtained prior to admission up to three months before hospitalization. Utilizing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, we assessed the association between AKI severity and progression with in-hospital mortality. AKI progression was defined as the increase from lower KGIDO stages of AKI to higher stages during the first seven days of hospitalization.
Results
Of the 116 patients who were reviewed in this study, 35 (30.2%) died during their hospitalization. The mean patient age was 62.9 ± 11.1 years. 64 (55.2%) and 87 (75.0%) were male and White respectively. Etiologies of MRA included peritoneal carcinomatosis (n=78; 67.2%) and portal hypertension caused by hepatic metastases (n=38; 32.8%). 45 (38.8%) patients had a baseline eGFR <60 ml/min/m2 and 44 (37.9%) patients progressed to a higher KDIGO AKI stage after initially fulfilling AKI criteria on admission. Patients achieved a peak severity of AKI stage 1, 35.3%, stage 2, 24.2%, and stage 3, 40.5%. AKI progression and need for kidney replacement therapy were significantly more common and peak AKI stage was higher in non-survivors than in survivors (P <0.001).
Conclusion
AKI in hospitalized patients with MRA is frequently severe and progressive and is associated with mortality in a stage-dependent manner. Methods for earlier identification of AKI and its progression may result in improved outcomes by facilitating the targeted and prompt management of AKI.