Acute Kidney Injury in the Outpatient Setting Associates with Risk of End-Stage Renal Disease and Death in Patients with CKD

Hung-Chieh Yeh,Chin-Chi Kuo,Hsiu-Yin Chiang,Han-Chun Huang,I.-Wen Ting

doi:10.1038/s41598-019-54227-6

Hung-Chieh Yeh, Chin-Chi Kuo + Show 3 more

Open Access

https://doi.org/10.1038/s41598-019-54227-6

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Abstract

Current acute kidney injury (AKI) diagnostic criteria are restricted to the inpatient setting. We proposed a new AKI diagnostic algorithm for the outpatient setting and evaluate whether outpatient AKI (AKIOPT) modifies the disease course among patients with chronic kidney disease (CKD) enrolled in the national predialysis registry. AKIOPT was detected when a 50% increase in serum creatinine level or 35% decline in eGFR was observed in the 180-day period prior to enrollment in the predialysis care program. Outcomes were progression to end-stage renal disease (ESRD) and all-cause mortality. Association analyses were performed using multiple Cox regression and coarsened exact matching (CEM) analysis. Among 6,046 patients, 31.5% (1,905 patients) had developed AKIOPT within the 180-day period before enrollment. The adjusted hazard ratios of the 1-year and overall risk of ESRD among patients with preceding AKIOPT compared with those without AKIOPT were 2.61 (95% CI: 2.15–3.18) and 1.97 (1.72–2.26), respectively. For 1-year and overall risk of all-cause mortality, patients with AKIOPT had respectively a 141% (95% CI: 89–209%) and 84% (56–117%) higher risk than those without AKIOPT. This statistical inference remained robust in CEM analysis. We also discovered a complete reversal in the eGFR slope before and after the AKIOPT from −10.61 ± 0.32 to 0.25 ± 0.30 mL/min/1.73 m2 per year; however, the loss of kidney function is not recovered. The new AKIOPT diagnostic algorithm provides prognostic insight in patients with CKD.

Highlights

By 2025, the International Society of Nephrology’s 0by[25] initiative aims to eliminate all avoidable death by acute kidney injury (AKI) worldwide[1]
To narrow this research gap, we evaluated the prognostic role of fluctuation in kidney function measured according to serum creatinine or estimated glomerular filtration rate in the outpatient setting throughout the 180-day period before the chronic kidney disease (CKD) patients were enrolled in a national pre-end-stage renal disease care program
Among patients with CKD who had a history of AKIOPT, 80.7% (n = 1573) had stable AKIOPT and nearly 20% (n = 368) had deteriorating AKIOPT (Table 1)

Summary

Introduction

By 2025, the International Society of Nephrology’s 0by[25] initiative aims to eliminate all avoidable death by acute kidney injury (AKI) worldwide[1]. To narrow this research gap, we evaluated the prognostic role of fluctuation in kidney function measured according to serum creatinine or estimated glomerular filtration rate (eGFR) in the outpatient setting throughout the 180-day period before the CKD patients were enrolled in a national pre-end-stage renal disease (pre-ESRD) care program. This phenotype of AKI was identified using our proposed diagnostic algorithm in an outpatient setting and was named outpatient AKI (AKIOPT). The diagnosis of AKIOPT is based on all available serum creatinine levels prior to the outpatient service no matter they were measured in the outpatient or inpatient setting

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