Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes
Rationale & Objective: Systematic evaluation of the prognosis from sepsis-associated acute kidney disease (SA-AKD) using real-world data is limited. This study aimed to use data algorithms on the electronic health records to trace the SA-AKD trajectory from acute kidney injury (AKI) to chron...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-03-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059524001705 |
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| author | Hsiu-Yin Chiang Chih-Chia Liang Ya-Luan Hsiao Uyen-Minh Le Yi-Ching Chang Pei-Shan Chen David Ray Chang I-Wen Ting Hung-Chieh Yeh Chin-Chi Kuo |
| author_facet | Hsiu-Yin Chiang Chih-Chia Liang Ya-Luan Hsiao Uyen-Minh Le Yi-Ching Chang Pei-Shan Chen David Ray Chang I-Wen Ting Hung-Chieh Yeh Chin-Chi Kuo |
| author_sort | Hsiu-Yin Chiang |
| collection | DOAJ |
| description | Rationale & Objective: Systematic evaluation of the prognosis from sepsis-associated acute kidney disease (SA-AKD) using real-world data is limited. This study aimed to use data algorithms on the electronic health records to trace the SA-AKD trajectory from acute kidney injury (AKI) to chronic kidney disease (CKD). Study Design: A retrospective cohort study. Setting & Participants: Adult inpatients with first sepsis episode surviving 90 days after AKD in a quaternary referral medical center. Exposure: We defined SA-AKD as having sustained ≥1.5-fold increased serum creatinine levels or initiating kidney replacement therapy after the SA-AKI, and we classified SA-AKD into recovery, relapse, and persistent SA-AKD subgroups. Outcomes: All-cause mortality, kidney replacement therapy (KRT), de novo nondialysis dependent CKD (CKD-ND), and late-recovery AKD during 1-year follow-up. Analytical Approach: A multivariable Cox proportional hazards models. Results: Of 24,038 eligible inpatients with sepsis, 42.2% had SA-AKI, and 17.6% progressed to SA-AKD (43.6% recovery, 8.3% relapse, 32.2% persistent, and 15.9% unclassified). Compared with the recovery subgroup, the 1-year mortality risk for the relapse, persistent, and unclassified SA-AKD subgroups were 1.57 (adjusted hazard ratios [aHRs]; 95% CI, 1.22-2.01), 1.36 (1.13-1.63), and 0.65 (0.48-0.89), respectively. Risks of KRT initiation were 3.27 (2.14-4.98), 6.01 (4.41-8.19), and 0.98 (0.55-1.74), respectively, and corresponding aHRs for de novo CKD-ND were 3.84 (2.82-5.22), 3.35 (2.61-4.29), and 0.48 (0.30-0.77), respectively. Patients with relapse SA-AKD had a higher likelihood of late recovery (aHR, 3.62; 95% CI, 2.52-5.21) than the persistent SA-AKD. Limitations: Selection bias and information bias could be present because of limiting population to sepsis survivors and because of no standardized follow-up protocol for kidney function. Conclusions: SA-AKD without recovery is associated with increased and long-term risks of KRT initiation, mortality, and increased risk of de novo CKD-ND for patients initially free of CKD. Further studies are warranted for managing AKI to AKD to CKD in real-world settings. Plain Language Summary: Systematic evaluation of the prognosis for sepsis-associated acute kidney injury (AKI) and sepsis-associated acute kidney disease (AKD) using real-world data remain limited. We applied standard definitions of sepsis and AKI/AKD and comprehensively profiled the AKI-AKD-chronic kidney disease (CKD) trajectory among sepsis survivors in a large, longitudinal hospital-based cohort. Our study showed that sepsis-associated AKD without recovery is associated with elevated and long-term risks of progressing to kidney replacement therapy, mortality, and new onset of CKD. These findings advocate for a paradigm shift toward digital therapies for managing the transition from AKI to AKD to CKD among patients with sepsis. |
| format | Article |
| id | doaj-art-7bbd4d936ba14d4cb00b01e0fdab724f |
| institution | Kabale University |
| issn | 2590-0595 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj-art-7bbd4d936ba14d4cb00b01e0fdab724f2025-02-06T05:12:41ZengElsevierKidney Medicine2590-05952025-03-0173100959Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and OutcomesHsiu-Yin Chiang0Chih-Chia Liang1Ya-Luan Hsiao2Uyen-Minh Le3Yi-Ching Chang4Pei-Shan Chen5David Ray Chang6I-Wen Ting7Hung-Chieh Yeh8Chin-Chi Kuo9Big Data Center, China Medical University Hospital, Taichung, Taiwan; Department of Biomedical Informatics, College of Medicine, China Medical University, Taichung, TaiwanDepartment of Biomedical Informatics, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Baltimore, MDDepartment of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MDBig Data Center, China Medical University Hospital, Taichung, TaiwanBig Data Center, China Medical University Hospital, Taichung, TaiwanBig Data Center, China Medical University Hospital, Taichung, TaiwanDivision of Nephrology, Department of Internal Medicine, China Medical University Hospital, Baltimore, MD; AKI-CARE (clinical advancement, research and education) Center, Department of Internal Medicine, China Medical University Hospital, Taichung, TaiwanDivision of Nephrology, Department of Internal Medicine, China Medical University Hospital, Baltimore, MDDivision of Nephrology, Department of Internal Medicine, China Medical University Hospital, Baltimore, MD; AKI-CARE (clinical advancement, research and education) Center, Department of Internal Medicine, China Medical University Hospital, Taichung, TaiwanBig Data Center, China Medical University Hospital, Taichung, Taiwan; Department of Biomedical Informatics, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Baltimore, MD; AKI-CARE (clinical advancement, research and education) Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Address for Correspondence: Chin-Chi Kuo, MD, PhD, Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan, No. 2, Yude Rd, North Dist, Taichung City 404.Rationale & Objective: Systematic evaluation of the prognosis from sepsis-associated acute kidney disease (SA-AKD) using real-world data is limited. This study aimed to use data algorithms on the electronic health records to trace the SA-AKD trajectory from acute kidney injury (AKI) to chronic kidney disease (CKD). Study Design: A retrospective cohort study. Setting & Participants: Adult inpatients with first sepsis episode surviving 90 days after AKD in a quaternary referral medical center. Exposure: We defined SA-AKD as having sustained ≥1.5-fold increased serum creatinine levels or initiating kidney replacement therapy after the SA-AKI, and we classified SA-AKD into recovery, relapse, and persistent SA-AKD subgroups. Outcomes: All-cause mortality, kidney replacement therapy (KRT), de novo nondialysis dependent CKD (CKD-ND), and late-recovery AKD during 1-year follow-up. Analytical Approach: A multivariable Cox proportional hazards models. Results: Of 24,038 eligible inpatients with sepsis, 42.2% had SA-AKI, and 17.6% progressed to SA-AKD (43.6% recovery, 8.3% relapse, 32.2% persistent, and 15.9% unclassified). Compared with the recovery subgroup, the 1-year mortality risk for the relapse, persistent, and unclassified SA-AKD subgroups were 1.57 (adjusted hazard ratios [aHRs]; 95% CI, 1.22-2.01), 1.36 (1.13-1.63), and 0.65 (0.48-0.89), respectively. Risks of KRT initiation were 3.27 (2.14-4.98), 6.01 (4.41-8.19), and 0.98 (0.55-1.74), respectively, and corresponding aHRs for de novo CKD-ND were 3.84 (2.82-5.22), 3.35 (2.61-4.29), and 0.48 (0.30-0.77), respectively. Patients with relapse SA-AKD had a higher likelihood of late recovery (aHR, 3.62; 95% CI, 2.52-5.21) than the persistent SA-AKD. Limitations: Selection bias and information bias could be present because of limiting population to sepsis survivors and because of no standardized follow-up protocol for kidney function. Conclusions: SA-AKD without recovery is associated with increased and long-term risks of KRT initiation, mortality, and increased risk of de novo CKD-ND for patients initially free of CKD. Further studies are warranted for managing AKI to AKD to CKD in real-world settings. Plain Language Summary: Systematic evaluation of the prognosis for sepsis-associated acute kidney injury (AKI) and sepsis-associated acute kidney disease (AKD) using real-world data remain limited. We applied standard definitions of sepsis and AKI/AKD and comprehensively profiled the AKI-AKD-chronic kidney disease (CKD) trajectory among sepsis survivors in a large, longitudinal hospital-based cohort. Our study showed that sepsis-associated AKD without recovery is associated with elevated and long-term risks of progressing to kidney replacement therapy, mortality, and new onset of CKD. These findings advocate for a paradigm shift toward digital therapies for managing the transition from AKI to AKD to CKD among patients with sepsis.http://www.sciencedirect.com/science/article/pii/S2590059524001705Sepsisacute kidney injuryacute kidney diseasekidney replacement therapymortality |
| spellingShingle | Hsiu-Yin Chiang Chih-Chia Liang Ya-Luan Hsiao Uyen-Minh Le Yi-Ching Chang Pei-Shan Chen David Ray Chang I-Wen Ting Hung-Chieh Yeh Chin-Chi Kuo Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes Kidney Medicine Sepsis acute kidney injury acute kidney disease kidney replacement therapy mortality |
| title | Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes |
| title_full | Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes |
| title_fullStr | Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes |
| title_full_unstemmed | Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes |
| title_short | Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes |
| title_sort | sepsis associated acute kidney disease incidence trajectory and outcomes |
| topic | Sepsis acute kidney injury acute kidney disease kidney replacement therapy mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2590059524001705 |
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