Transcript Slide 1

Complete Recovery of Renal Function After Acute Kidney Injury is Associated with
Long-Term All-Cause Mortality In a Large Managed Care Organization
Jennifer deGraauw MD1, John Holmen, PhD2, Jason Jones, PhD2, Sid Thornton, PhD2,
Jim Stinson, MD2, Michel Chonchol, MD1
1University
of Colorado Denver, Aurora, CO; 2Homer Warner Center Intermountain Healthcare, Salt Lake City, UT
Background
•Acute Kidney Injury (AKI) is increasingly common and is
associated with high in-hospital mortality.
•The incidence of AKI from all causes has increased over the past
decade.
Results
Table 1: Baseline Characteristics of AKI Group
Parameter
With AKI
(n=1411)
p-value
(Balance)
Age (10yrs) ***
Female *
•Previous studies have demonstrated an increased risk of longterm mortality after an episode of AKI.
Age , mean (SD), years
•Less is known about the long-term outcomes of patients that
have full renal recovery after an episode of AKI.
Female (%)
•Our study sought to determine the long-term mortality risk in
subjects that have complete recovery of renal function after an
episode of AKI.
Figure 2: Risk of Long-term Mortality in Subjects with AKI by
Participant Characteristics Mortality in AKI Patients
Race, Black, (%)
63±17
0.06
45%
0.99
9%
AMI
Cancer ***
Cancer w/ Mets ***
0.99
Cerebrovascular Dis. ***
Hypertension (%)
74%
0.99
Diabetes Mellitus (%)
58%
0.99
Heart Failure ***
Chronic Pulm Dis.
Dementia ***
•Outcome
•All-cause mortality occurring after hospital discharge.
Analyses
•Follow-up was performed until March 31, 2010.
•Hazard ratios and 95% confidence intervals were derived from
Cox proportional hazard models, incorporating the 1:1 matched
design, and adjusting for differences not addressed by the
matching procedure.
39%
0.99
Perivascular Disease (%)
21%
<0.0001
Mod/Sev Liver Dis.
Periph Vasc Dis. ***
HTN (SBP>140) **
Cerebrovascular Disease (%)
23%
0
1.0
0.8
0.6
0.4
200
2
3
4
•Table 1 demonstrates the baseline characteristics of the AKI
group.
•Figure 1 illustrates the Kaplan-Meier curve for long-term
mortality (log rank test, p < 0.0001).
•Table 2 demonstrates the Hazard Ratios (95% CI) for allcause mortality. After adjusting for differences not addressed
by the matching procedure patients with AKI had a 36%
increase risk in all-cause mortality.
•Figure 2 illustrates the risk of long-term mortality in subjects
with AKI by participant characteristics.
___ AKI group
___ No AKI group
log rank test, p <0.0001
100
1
Univariate HR
Figure 1: Kaplan–Meier Curve for All-cause
mortality
M ortality
0
Conclusions
<0.0001
All values are expressed as mean ± standard deviations or %=percentage of patients
0.2
Predictor
•AKI cases were identified within the hospitalization by comparing
the highest serum creatinine value during the index hospitalization
with the lowest serum creatinine value recorded in the 90 days
prior the index admission.
•Ratio of those two values greater than 1.5, the hospitalization was
classified as “with AKI” (AKIN definition).
•Completed renal recovery existed if the serum creatinine returned
to a level less than 50% above baseline serum creatinine.
•A total of 1,411 patients with AKI and 1,411 matched controls were
included in this analyses.
0.33
Heart failure (%)
0.0
Study Population
•Retrospective matched cohort study using a large comprehensive
database from Intermountain Healthcare System.
•Adults with at least one hospitalization between January 1999March 2009 and had 1 yr of health care prior to date of
hospitalization. Median [IQR] follow-up: 2.8 [1.3;5.6] years.
•Normal renal function (SCr < 1.3 mg/dL) within 90 days prior to
hospital admission.
19%
DM w/ Complications
Non-Event Rate
Methods
Myocardial Infarction (%)
300
400
500
600
Days from Discharge
Table 2: Hazard ratio (95% CI) for All-Cause Mortality
Unadjusted HR
1.76 (1.54; 2.01)
(95% CI)
Adjusted HR
(95% CI)
Adjusted for PVD, CVA, Liver Disease, Malignancy, CTD and PUD
1.36 (1.17; 1.57)
700
Conclusions
•Subjects with complete renal recovery after an episode of AKI
have an increased risk of long-term mortality as compared to
matched controls, even after adjusting for important
confounders.
•The leading causes of death in the AKI group were
malignancy, cardiovascular, and infectious.
•Further studies are needed to confirm these results in other
Printed by
populations.