#4792 SECOND, THIRD, AND MORE HITS: IMPACT OF SUCCESSIVE AKI EPISODES ON CKD PROGRESSION AND AKI TO CKD TRANSITION

Abstract

Abstract Background and Aims The second hit theory refers to the link between two or more deleterious events that cause AKI simultaneously (e.g., triple whammy) or successively (e.g., cardiac surgery after coronary angiography). We investigated the effect of 3 or more consecutive AKI episodes on baseline serum creatinine (SCr) and if these changes leaded to AKI to CKD transition (Transition), CKD progression (Progression) or stable SCr. Method Retrospective study of patients with AKI attended by nephrology during a 3-year period. AKI severity was categorized by KDIGO criteria. We searched for patient's successive admissions and if suffered a new AKI episode and included all patients with ≥3 AKI episodes during the study period. We analyzed the baseline SCr for every episode and investigated if serial AKI episodes leaded to incident CKD, Progression, or no changes in SCr. Results 144 individuals that suffered 525 AKI episodes were included. We observed 36 patients in the Transition, 70 in the Progression group, and 38 didn't vary their SCr. We found no statistically significant differences in hypertension, DM, Charlson's Index, admission to ICU, severity of AKI or length of stay between groups. See Table 1A. We found that progressors had shorter time to nephrology consultation, they were more prone to receive acute HD and to be dialysis dependent at discharge. With no difference in the mortality rate between groups. See Table 1B. Figure 1 plots baseline SCr of every episode that shows a trend to incremental cyphers. Conclusion In our study the clinical characteristics between Transition and Progression groups were similar. We observed more individuals in the Progression group and their time to nephrology consultation was significantly shorter, maybe because no nephrology specialists are afraid of managing CKD patients. Patients that progressed needed acute HD more frequently and were more dialysis dependent at discharge, this finding could be explained by their diminished renal reserve, with no differences in the rate of in-hospital mortality. Successive AKI episodes portend a higher risk of adverse clinical outcomes, with excessive burden for patients with previous CKD. New AKI therapies could change the course of these ominous outcomes? This issue is under intense investigation, but it is very difficult to translate bench to bedside. Therefore, now we can only count on prevention and timely nephrological attention.