Epidemiological Risk Factors for Acute Kidney Injury Outcomes in Hospitalized Adult Patients: A Multicenter Cohort Study
Tomonori Takeuchi, AKM F Rahman, Lama Ghazi, Orson W Moe, Robert D Toto, Edward D Siew, Javier A Neyra, Orlando M GutierrezAbstract
Background
Multiple studies have identified risk factors for acute kidney injury (AKI) in hospitalized patients, but less is known about factors associated with AKI severity, including non-recovery of AKI.
Methods
Retrospective cohort study of adults (≥18 years) hospitalized between 2014 and 2017 at 3 US academic medical centers. Study outcomes included incidence of AKI and non-recovery from AKI at hospital discharge in those who survived hospitalization. AKI was defined by KDIGO serum creatinine criteria. Non-AKI recovery was defined as persistent AKI stage ≥ 1 at time of discharge. Multivariable models assessed the association of risk factors for each outcome, focusing on race, diabetes, and obesity (BMI ≥30 vs. <30 kg/m2), and adjusting for potential confounders.
Results
Among 56 056 patients included in the study (mean age 57, 25% Black, 48% women), 12 954 (23%) developed AKI. In adjusted models, Black race (OR 1.26, 95%CI: 1.20–1.32), diabetes (OR 1.14, 95%CI: 1.08–1.19) and obesity (OR 1.14, 95%CI: 1.10–1.20) were all associated with incident AKI. A total of 3 591 of the 11 672 (30.8%) patients with AKI who survived until discharge had AKI non-recovery. In adjusted models, obesity (OR 1.27, 95%CI: 1.17–1.39) was independently associated with higher risk of AKI non-recovery at hospital discharge.
Conclusions
Black race, diabetes, and obesity were associated with the development of AKI in hospitalized patients but only obesity was associated with non-recovery from AKI at hospital discharge. These findings emphasize the growing relevance of obesity as an epidemiological risk factor of AKI.