P78
LONG TERM OUTCOME WITH ACUTE KIDNEY INJURY IN HOSPITALIZED
PATIENTS IN TERMS OF RECOVERY OF KIDNEY FUNCTION AND SURVIVAL
Ramappa, A2, Dymond, T2, Gbadebo, A2, Khalil, A1, Ahmed, S1
1
Department of Nephrology, Royal Liverpool University Hospital, 2Warrington General
Hospital
INTRODUCTION AND AIMS: Acute kidney injury (AKI) is common in hospitalized patient with
serious consequences in terms of mortality, morbidity and cost. We conducted a retrospective audit on
inpatients referred to Nephrology team from various specialties with AKI. The aim was to assess the
short and long term outcome post AKI in terms of renal recovery, prevalence of Chronic Kidney
Disease (CKD) and mortality. We used our Cheshire and Merseyside, UK AKI policy guideline as
reference standard (1).
METHODS: Total 78 cases were reviewed retrospectively between October 2009 to January 2012.
We reviewed serum creatinine (CR) and eGFR (estimated glomerular filtration rate) value during
admission, base line value prior to admission, follow up value at 6 and 12 months post discharge and
also maximum CR rise value during AKI episode . We also looked at the number of patients who
were deceased both in - hospital and post discharge. We used AKIN AKI classification and definition
to stage the AKI cases (2).
RESULTS: The age varied between 35 yr to 89 yr with mean age of 69 yr. Mean serum CR values at
baseline was 167mcmol/L, at admission 360mcmol/L, maximum mean rise 431mcmol/L and one year
follow up mean CR was 196mcmol/L ( table 1). There was a drop of mean eGFR by 14% from the
baseline at 1 yr follow up. Out of 78 case referred, AKI stage 1 were 25% (n=20), AKI stage 2 were 8
%( n=6), AKI stage 3 were 59 %( n=46). We could not stage about 8 %( n=6) of patients due to lack
of available baseline CR. A total of 32% (n=25) of patients died during 3 yr period since AKI episode.
Among deceased patients, 40% (n=10) were in hospital death and 60% died during follow up period
post discharge ;64% of total deceased (n=16)were in stage 3 AKI.
Table 1: Renal Function at 12 months following AKI episode
Mean Values of:
Baseline Admission
Maximum Rise
At 6 Month
At 12 Month
Creatinine(mcmol/L)
167
360
430
218
196
eGFR (mls/min/1.73m2)
42
20
non applicable
34
36
eGFR= estimated GFR
CONCLUSIONS: There is higher risk of developing long term CKD post AKI episode contributing
to long term CKD related co-morbidities and mortality. There is also high mortality risk during
inpatient stay with AKI and higher with stage 3 AKI. It demonstrates the importance of early
identification and management of AKI patients to prevent CKD and reduce mortality.
References:
1. New guidelines for Acute Kidney Injury. M S Ahmed, GM Bell. Kidney Care Matters, November
2009. http://www.kidneycarematters.nhs.uk
2. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury,
Ravindra L Mehta, Adeera Levin and the Acute Kidney Injury Network, Critical Care 2007, 11:R31