AKI-induced kidney failure confers highest mortality rates, recovery varies by sex, race
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Patients who developed kidney failure due to AKI had a higher risk for mortality than those who developed the condition from diabetes or other causes, according to study results.
Additional findings indicated that women and Black, Asian, Hispanic and Native American patients had a lower likelihood of kidney recovery than men and white patients.
“Morbidity, mortality and costs of care are among the highest during the transition to maintenance dialysis, particularly in the first year of dialysis care,” Silvi Shah, MD, assistant professor in the division of nephrology, Kidney CARE Program, at the University of Cincinnati, and colleagues wrote. “However, whether these outcomes differ across patients with kidney failure due to AKI compared with those due to diabetes or other causes is not well understood.”
Furthermore, the researchers noted that while sex and racial disparities are well-documented in dialysis care, vascular access and mortality rates, little is known about potential disparities in kidney recovery following AKI.
“[The] current literature contains key knowledge gaps regarding kidney failure due to AKI that impede our ability to deliver appropriate care to these patients on incident dialysis and to potentially promote kidney recovery,” the researchers argued.
To address these “knowledge gaps,” Shah and colleagues used the U.S. Renal Data System, from which they identified 1,045,540 patients on incident dialysis (mean age, 63 years; 43% were female patients; 28% were Black patients; 54% were white patients). Of these, 3% had kidney failure due to AKI, 46% had kidney failure due to diabetes mellitus and 51% had kidney failure due to other causes.
Overall mortality was 0.19 deaths per person-year (n = 21,411), with patients with AKI-induced kidney failure having higher 12-month (35%; n = 11,456 or 0.45 deaths PPY) and 3-month morality (15%; n = 4,990 or 0.66 deaths PPY) compared with those who developed kidney failure from diabetes or other causes.
In addition, at 0 to 3 months and at 3 to 6 months following dialysis initiation, researchers found kidney failure attributed to AKI was associated with higher mortality than kidney failure due to diabetes (28% and 16% higher adjusted hazards of death, respectively).
Patients with kidney failure due to AKI also had a higher hazard of death compared with those with kidney failure due to other causes (0 to 3 months, adjusted HR [aHR]= 1.06; 3 to 6 months, aHR = 1.09).
When examining recovery patterns, researchers found 35% of all patients eventually recovered their kidney function, with most of these doing so within a year (95%).
Women were found to have a lower likelihood of kidney recovery (aHR = 0.86) than men, while Black, Asian, Hispanic and Native American patients had a lower likelihood of recovery than white patients (aHRs of 0.68, 0.82, 0.82 and 0.72, respectively).
“These observations strongly caution against implementing a ‘one-size-fits-all’ model of incident dialysis care and suggest the necessity of customized care for those with kidney failure due to AKI,” the researchers contended. “The initial higher risk of death in subjects with kidney failure due to AKI could be conferred by their acute care hospitalizations prior to transitioning to long-term dialysis because of their severity of illness when they initiate dialysis. Additionally, some standardized dialysis care treatments or practices may be potentially harmful to patients with AKI, particularly when implemented during the early post-AKI phase.”
Shah and colleagues recommend more studies be conducted to tailor dialysis treatment options to those with AKI-induced kidney failure. These studies should primarily focus on women and multiracial groups, they wrote.
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