Predictors of Recurrent AKI

Abstract

Recurrent AKI is common among patients after hospitalized AKI and is associated with progressive CKD. In this study, we identified clinical risk factors for recurrent AKI present during index AKI hospitalizations that occurred between 2003 and 2010 using a regional Veterans Administration database in the United States. AKI was defined as a 0.3 mg/dl or 50% increase from a baseline creatinine measure. The primary outcome was hospitalization with recurrent AKI within 12 months of discharge from the index hospitalization. Time to recurrent AKI was examined using Cox regression analysis, and sensitivity analyses were performed using a competing risk approach. Among 11,683 qualifying AKI hospitalizations, 2954 patients (25%) were hospitalized with recurrent AKI within 12 months of discharge. Median time to recurrent AKI within 12 months was 64 (interquartile range 19-167) days. In addition to known demographic and comorbid risk factors for AKI, patients with longer AKI duration and those whose discharge diagnosis at index AKI hospitalization included congestive heart failure (primary diagnosis), decompensated advanced liver disease, cancer with or without chemotherapy, acute coronary syndrome, or volume depletion, were at highest risk for being hospitalized with recurrent AKI. Risk factors identified were similar when a competing risk model for death was applied. In conclusion, several inpatient conditions associated with AKI may increase the risk for recurrent AKI. These findings should facilitate risk stratification, guide appropriate patient referral after AKI, and help generate potential risk reduction strategies. Efforts to identify modifiable factors to prevent recurrent AKI in these patients are warranted.

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…5). For example, patients who have more severe or persistent AKD 11,96 , those with premorbid conditions that increase the risk of future CKD progression (for example, those with evidence of pre-existing CKD, diabetes and/or proteinuria), and those with recurrent disease or non-recovery (for example, those with congestive heart failure, cirrhosis, and/or malignancy with or without chemotherapy) might achieve greater benefit from earlier or more frequent surveillance than patients with a lower risk of future CKD 97,98 . This hypothesis is supported by data showing that rates of re-hospitalization and recurrent AKI are high among patients with similar risk factors 95,[98][99][100][101][102][103][104] .…”

Impact of Recurrent Acute Kidney Injury on Patient Outcomes

“…Briefly, patients were classified into the “risk” category if serum creatinine increased 1.5-fold, or glomerular filtration rate (GFR) decreased 25%; “injury” if SCr increased 2-fold or GFR decreased 50% and “failure” if SCr increased 3-fold or GFR decreased 75% [22]. The outcome criteria of loss of renal function and ESRD was defined by the duration of AKI [23]. Urine output criteria were not used in diagnosis or staging because data were not available in most patients.…”

Care of the Acute Kidney Injury Survivor

“…In a study of >150,000 patients hospitalized with AKI in Ontario, Canada, we showed that readmissions to hospital within 30 days were significantly more likely (aHR 1.53, 95% CI 1.50–1.57) among AKI survivors relative to propensity score-matched patients without AKI [13]. Using Veterans’ Administration data, Siew et al[14] further demonstrated a 25% cumulative incidence of recurrent AKI with the majority of such events occurring within the first 90 days from discharge after the initial AKI-related hospitalization. Key risk factors for recurrent AKI included older age, pre-existing comorbidities (CKD, diabetes, coronary disease and dementia), specific etiologies of the index hospitalization (heart failure, malignancy) and the receipt of chemotherapy on the index hospitalization.…”