PREDICTORS OF ONSET OF SEVERE ACUTE KIDNEY INJURY AND ITS PROGRESSION IN NON-INTENSIVE CARE UNIT PATIENTS: INSIGHTS FROM SECONDARY ANALYSIS OF THE PERFORM-AKI STUDY

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Abstract Title *

PREDICTORS OF ONSET OF SEVERE ACUTE KIDNEY INJURY AND ITS PROGRESSION IN NON-INTENSIVE CARE UNIT PATIENTS: INSIGHTS FROM SECONDARY ANALYSIS OF THE PERFORM-AKI STUDY

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Co-author 1

Mayy Hamde mayy.hamde@health.nsw.gov.au Concord Repatriation and General Hospital Department of Renal Medicine Sydney Australia -

Co-author 2

Severine Bompoint sbompoint@georgeinstitute.org The George Institute for Global Health, University of NSW Sydney Australia -

Co-author 3

Rimma Myton RMyton@georgeinstitute.org.au The George Institute for Global Health, University of NSW Sydney Australia -

Co-author 4

Kathryn Higgins khiggins@georgeinstitute.org.au The George Institute for Global Health, University of NSW Sydney Australia -

Co-author 5

Jonathan Ngo Johnathan.Ngo@health.nsw.gov.au Liverpool Hospital Department of Renal Medicine Sydney Australia -

Co-author 6

Martin Gallagher Martin.Gallagher@health.nsw.gov.au The George Institute for Global Health, University of NSW Sydney Australia -

Co-author 7

Amanda Wang Ying.Wang3@health.nsw.gov.au The George Institute for Global Health, University of NSW Sydney Australia *

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Acute kidney injury (AKI) poses a significant and growing global health challenge, affecting approximately 7% of hospitalised adults with high rates of prolonged hospitalisation, morbidity, and mortality. Considerable research has focused on AKI in intensive care unit (ICU) populations, however AKI occurring outside of ICU settings remain understudied despite being larger in scale and characterised by more diverse aetiologies.

Methods

PERFORM-AKI is a prospective, multi-centre cohort study conducted across five hospitals across Sydney, Australia. Data was gathered from the electronic medical records of 639 participants aged 18 years or older, who were diagnosed with AKI outside the ICU setting between January 2021 to October 2023. The aetiology and management of AKI at initial consultation and at 14 days follow-up were collected, and multivariate analyses performed to identify risk factors associated with onset of severe AKI and its progression.

Results

The study included a total of 617 patients with non-ICU AKI, with the mean age of 74.9 years (SD 14.5 years). Patients were predominantly male (56.7%) with prevalent co-morbid conditions including hypertension (77.8%), cardiovascular disease (58.7%), and diabetes (44.6%). Multivariate analysis showed that baseline creatinine levels (OR 1.05, 95% CI 1.01-1.10, P=0.02) were independently associated with increased odds of severe AKI on initial consultation, while a history of chronic kidney disease (OR 0.14, 95% CI 0.07-0.28, P<0.001) and diabetes (OR 0.52, 95% CI 0.30-0.89, P=0.02) were associated with reduced odds of severe AKI. Of note, among patients with pre-existing CKD at baseline, only 12% of them had severe AKI. Predictors of progression of severe AKI at 14-days included lower haemoglobin levels (P=0.01), higher baseline creatinine level (P<0.0001) and pre-existing CKD (P=0.04).

Conclusion

This unique prospective non-ICU AKI cohort highlights the epidemiology and substantial burden of severe AKI in the non-ICU population, and identifies key risk factors for both its onset and progression. High-risk hospitalised patients warrant targeted AKI surveillance, preventative and management protocols.

Kewords