Subgroups of Patients with Distinct Health Utility Profiles after AKI.

Abstract

A large amount of inter-individual variability exists in health-related quality of life outcomes following acute kidney injury (AKI). This study aimed to determine if subgroups of early AKI survivors could be identified based on distinct health utility impairment profiles ascertained at 60 days after AKI and if these subgroups differed in clinical and biomarker characteristics at index hospitalization and outcomes at 1-year follow up. This retrospective analysis used data from the BioMaRK study, an observational subcohort of the Acute Renal Failure Trial Network study. Of 402 patients who survived to 60 days after AKI, 338 completed the Health Utility Index-3 survey which measures impairments in 8 health attributes. Latent class analysis was used to identify subgroups of patients with distinct health utility profiles. Three subgroups with distinct health utility impairment profiles were identified: Low (28% of participants), Moderate (58%) and High (14%) with a median of 1, 4, and 6 impairments across the 8 health attributes at 60 days after AKI, respectively. Patient subgroups differed in weight, history of cerebrovascular disease, intensity of dialysis, hospital length of stay, and dialysis dependence. Serum creatinine and blood urea nitrogen at index hospitalization did not differ among the 3 subgroups. The High impairment subgroup had higher levels of interleukin-6 and soluble tumor necrosis factor receptor-2 at study day 1. The 3 subgroups had different 1-year mortality rates: 5% in the Low, 21% in the Moderate, and 52% in the High impairment subgroup. Patient subgroups with distinct health utility impairment profiles can be identified 60 days after AKI. These subgroups have different characteristics at index hospitalization. A higher level of impairment at 60 days was associated with decreased survival.