M MAAWAD 1, A KANG 1,2, D CHRISTALDI 1, S KOTWAL 1,2, Z ENDRE 1
1The Prince Of Wales Hospital, Randwick, Australia, 2The George Institute for Global Health, Sydney, Australia
Aim: To evaluate progression to acute kidney disease (AKD) and chronic kidney disease (CKD) after hospital-acquired acute kidney injury (AKI).
Background: AKI, AKD and CKD are common and increasingly recognized as a single disease process. Few prospective studies describe outpatient outcomes after AKI.
Method: The outcomes of patients referred to AKI follow-up within 30 days of an AKI episode between 1/1/2020 and 31/12/2020 were audited. Serum creatinine, eGFR, maximum AKI stage, and clinic interventions were evaluated at baseline, within, and after 90 days of AKI. Follow-up status was categorised as complete recovery (creatinine within 10% of baseline within 7 days), AKD (persistent AKI between 7 and 90 days) or CKD (AKD beyond 90 days).
Results: Of 86 referred patients, 64 attended. The majority were male (63%), and older than 65 years (69%). Most attended within 30 days of discharge after AKI (58%); 86% attended within 90 days. Baseline hypertension (77%), diabetes mellitus (41%), proteinuria (73%) and eGFR<90 ml/min (82%) were common. AKI stages were equally distributed (approximately 30% for each stage). Complete recovery of kidney function within 7 days occurred in 45%, 14% had AKD while 41% progressed to CKD. At 90 days, 22% were re-hospitalised and 13% had recurrent AKI. In those with CKD progression, pre-existing diabetes (52%) and hypertension (91%) were common. Renin Angiotensin Aldosterone System inhibitors were restarted in 50 % of patients at follow-up.
Conclusion: The majority of patients with AKI are older with prior CKD and demonstrated persistent or further loss of kidney function. AKI follow-up is important to detect progressive kidney disease and optimise care consistent with KDIGO guidelines.
Dr Maawad is a nephrologist with more than 10 years experience in clinical nephrology globally and has a keen interest in Acute Kidney Injury. She is currently working as the AKI Fellow at Prince of Wales Hospital. She has designed, led and conducted all aspects of this project.