A STUDY ON THE ROLE OF ACUTE KIDNEY INJURY ON CHRONIC KIDNEY DISEASE PROGRESSION AND MORTALITY

Introduction:

Chronic Kidney Disease (CKD) affects 13% of the population. Identifying and addressing the risk factors for CKD progression is of paramount importance given the high morbidity, mortality & health care cost of advanced renal disease. Acute Kidney Injury(AKI)leaves behind some residual damage which can accelerate the progression of CKD. This study looked at  the accentuating effect of AKI on CKD progression and mortality.

Methods:

This single center non blinded prospective hospital based cohort study was conducted from May 22 to Dec 23. The primary objective was to study the mortality and risk of progression to dialysis requiring stage in KDIGO stage 3 &4 CKD patients who experience a single episode of AKI.  Patients of any gender ≥18 years of age who survive an episode of acute on CKD were enrolled as the exposure cohort at the time of hospital discharge. CKD patients with stable renal function formed the control cohort(Table1).The sample size was calculated with assumption of 80% power,5% alpha error &attrition rate of 10%. 100 patients were enrolled in each group on a first come first serve basis. Baseline data collected& followed up monthly for 6 months. Data on dialysis initiation, mortality and eGFR collected during each visit(Table2).Relative risk (RR) for primary outcomes were calculated. The  survival rate and renal replacement therapy–free survival rates were analyzed using  the Kaplan-Meier(KM) plot. Cox regression analysis was done to study the association of outcomes with study variables.

Results:

95 patients in the exposure cohort and 97 in the control group were included in the final analysis. The required number of samples in each group was 95. 41.1% in the exposure group and 36.1 %in the control group were females. The most common etiology of CKD was diabetic nephropathy. The control group had higher mean age(66±10.2 vs 62±9.6years,p-0.009).The baseline eGFR was comparable between the groups(32.5±11 vs 34.8±8.2p-0.11). Baseline lab reports are given in Table3. By the end of 6 month follow up period 28 patients (29.4%) in the exposure groups and 7 (7.6%) in the control group were started on maintenance hemodialysis. The RR for dialysis initiation was 4.08(1.8-8.8). KM analysis showed significant difference between the curves by Log rank test (X2-15.6, p-<0.001)Graph1.  On cox regression hazard ratio(HR) for AKI was 4.46 (CI-1.95-10.2, p- <0.001). Duration of CKD, baseline eGFR, use of dialysis therapy for AKI and baseline hemoglobin were the other factors associated with significant hazard ratio for progression to dialysis(Table3). Mortality occurred in 11.5% among exposure group and 5.1% among control(Log rank –X2-2.5, p-0.114). HR was 0.439(CI 0.152-1.263,p-0.116).The RR for death was 2.2(0.8-6.2). The GFR slope between the two group was studied using mixed model linear regression and was found to be significantly different(p<0.001).

Conclusions:

In patients with KDIGO stage 3 &4 CKD, an episode of superimposed AKI increase the risk of progression to dialysis dependent stage within the next 6 months by 4.4 times compared to controls. The decline in GFR is also faster after the event.6 month mortality was also higher in survivors of acute on CKD though did not reach the threshold for statistical significance.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.