Predictors of Recurrent AKI.
Recurrent AKI is common among patients after hospitalized AKI and is associated with progressive CKD. In this study, we identified clinical risk factors for recurrent AKI present during index AKI hospitalizations that occurred between 2003 and 2010 using a regional Veterans Administration database in the United States. AKI was defined as a 0.3 mg/dl or 50% increase from a baseline creatinine measure. The primary outcome was hospitalization with recurrent AKI within 12 months of discharge from the index hospitalization. Time to recurrent AKI was examined using Cox regression analysis, and sensitivity analyses were performed using a competing risk approach. Among 11,683 qualifying AKI hospitalizations, 2954 patients (25%) were hospitalized with recurrent AKI within 12 months of discharge. Median time to recurrent AKI within 12 months was 64 (interquartile range 19-167) days. In addition to known demographic and comorbid risk factors for AKI, patients with longer AKI duration and those whose discharge diagnosis at index AKI hospitalization included congestive heart failure (primary diagnosis), decompensated advanced liver disease, cancer with or without chemotherapy, acute coronary syndrome, or volume depletion, were at highest risk for being hospitalized with recurrent AKI. Risk factors identified were similar when a competing risk model for death was applied. In conclusion, several inpatient conditions associated with AKI may increase the risk for recurrent AKI. These findings should facilitate risk stratification, guide appropriate patient referral after AKI, and help generate potential risk reduction strategies. Efforts to identify modifiable factors to prevent recurrent AKI in these patients are warranted.
Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Center for Kidney Disease (VCKD), Nashville, Tennessee; edward.siew@vanderbilt.edu.
Edward D
ED
Siew
Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Center for Kidney Disease (VCKD), Nashville, Tennessee;
Sharidan K
SK
Parr
Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Center for Kidney Disease (VCKD), Nashville, Tennessee;
Khaled
K
Abdel-Kader
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee;
Svetlana K
SK
Eden
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee;
Josh F
JF
Peterson
Division of Nephrology, Department of Medicine, University of Washington, Washington, DC;
Nisha
N
Bansal
Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Center for Kidney Disease (VCKD), Nashville, Tennessee;
Adriana M
AM
Hung
Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration;
James
J
Fly
Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; TVHS Geriatric Research Education and Clinical Centers; and.
Ted
T
Speroff
Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Center for Kidney Disease (VCKD), Nashville, Tennessee;
T Alp
TA
Ikizler
Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; TVHS Geriatric Research Education and Clinical Centers; and Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Michael E
ME
Matheny
D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
acute renal failure; clinical epidemiology; outcomes