S1209 Longer Time to Recovery From Acute Kidney Injury Is Associated with Increased Major Adverse Kidney Events in Patients With Cirrhosis

Abstract

Introduction: In patients with cirrhosis, non-recovery from acute kidney injury (AKI) is associated with major adverse kidney events (MAKE). However, in patients with AKI recovery, little is known about how the timing of recovery affects the risk of MAKE. Thus, we aimed to examine the association between timing of recovery and risk of MAKE in patients with AKI recovery. Methods: Hospitalized patients with cirrhosis and AKI in the Cerner Health Facts database from 1/2009-09/2017 were assessed for AKI recovery and were followed for 180 days for outcomes. The timing of AKI recovery [return of serum creatinine (sCr) < 0.3mg/dL of baseline] from AKI onset was grouped into 0-2, 3-7, 8-14, and >14 days. The primary outcome was MAKE at 90-180 days. Per consensus definition, MAKE was defined as the composite outcome of >25% decline in estimated glomerular filtration rate (eGFR) compared with baseline with CKD stage >3 or progression of CKD (defined as >50% reduction in eGFR compared with baseline) or new hemodialysis. Competing risk multivariable modeling (death/transplant as competing risk) was performed to determine the independent association between timing of recovery and risk of MAKE. Results: Out of 6,250 eligible patients, 4,655 (75%) achieved AKI recovery. The median age was 60 years [interquartile range (IQR) 25, 70], 71% White and 60% male. The most common etiologies of cirrhosis were non-alcoholic steatohepatitis (38%), alcohol (27%), and hepatitis C (17%), and the median (IQR) MELD-Na score was 23 (16, 28). 60% had ascites and the median baseline sCr was 1.00 (0.70, 1.44) mg/dL. The characteristics of patients who recovered 0-2 (n=2,791, 60%), 3-7 (n=1,455, 31%), , 8-14 (n=255, 5%), and >14 days (n=184, 4%) after AKI are shown in Table. The incidence of MAKE was 12%, 16%, 22%, and 25% for 0-2, 3-7, 8-14, and >14 days recovery groups, respectively. On adjusted multivariable competing risk analysis, compared to 0-2 days, recovery at 3-7, 8-14, and >14 days was independently associated with an increased risk for MAKE: sHR 1.48 (95% CI 1.03-2.14, p=0.036), sHR 2.92 (95% CI 1.11-4.31, p=0.023), and sHR 2.60 (95% CI 1.37-4.96, p=0.004), respectively. Conclusion: In patients with cirrhosis who recover from AKI, longer time to recovery is associated with an increased risk of major adverse kidney events. Interventions to hasten recovery from AKI should be considered in patients with cirrhosis who develop AKI. Table 1. - Comparison of Patient and Clinical Demographics Between AKI Recovery Groups Variable 0-2 Days N=2,791 3-8 Days N=1,455 8-14 days N=225 >14 days N=184 P-value Age 60 (52, 69) 62 (53, 71) 62 (55, 71) 60 (50, 68) < 0.001 Race, white 71 71 68 68 0.069 Sex, male 61 59 60 59 0.925 Etiology of cirrhosis Hepatitis C Alcohol NASH Other Unknown etiology 17 29 37 5 12 18 24 40 6 12 17 19 47 6 11 21 27 34 6 12 0.635 0.001 0.006 0.518 0.966 Ascites 56 66 68 73 < 0.001 Hepatic encephalopathy 25 27 31 32 0.054 Diabetes 50 55 64 54 < 0.001 Hypertension 57 60 63 9 0.044 Baseline creatinine, mg/dL 0.94 (0.70, 1.44) 1.00 (0.74, 1.42) 1.10 (0.80, 1.74) 1.07 (0.76, 1.82) < 0.001 MELD-Na at time of AKI 20 (14, 26) 24 (19, 29) 26 (21, 30) 26 (23, 31) < 0.001 Stage of AKI at diagnosis 1/2/3 87/10/3 69/20/11 61/21/18 63/14/13 < 0.001 Peak AKI stage 1/2/3 75/13/12 48/27/25 20/31/49 16/21/63 < 0.001 Infection 25 30 41 35 < 0.001 Required ICU care 24 28 37 33 < 0.001 Mechanical ventilation use 12 14 24 12 < 0.001 Vasopressor use 14 17 24 23 < 0.001 Continuous variables shown as median interquartile range (IQR); categorical variables presented as %.