MP278RENAL OUTCOME OF DIABETIC VERSUS NONDIABETIC PATIENTS WITH ACUTE KIDNEY INJURY

Abstract

INTRODUCTION AND AIMS: Diabetes mellitus (DM) is a major risk factor for kidney disease. The incidence of diabetic-related end-stage renal disease (ESRD) requiring dialysis or kidney transplantation is rising worldwide. Acute kidney injury (AKI) on diabetic patients may accelerate this progression causing more morbidity and decreased quality of life. In this study, we aimed to compare the renal outcomes of diabetic vs. non-diabetic patients with AKI after discharge. METHODS: We retrospectively enrolled 316 patients aged ≥ 18 years old who were admitted with AKI (measured as an increase of at least ≥ 0.3 mg/dL or 1.5-2x their baseline creatinine). Baseline variables, Charlson score index (CSI) and laboratory data were collected at admission, upon discharge and over 1 month after. Two groups were created: group A (diabetic) (n=130, 41%) and group B (non-diabetic) (n=186, 59%). Patients with stage 5 chronic kidney disease (CKD) were excluded. RESULTS: A total of 316 patients (male, 53%) with a mean age 75 ± 14 (range 18-98) years were selected; 37% (n=117) were elderly (≥ 65 years) and 44% (n=140) very elderly (≥ 80 years); 192 (61%) started dialysis during admission and 94 (30%) were dialysis-dependent 30 days after discharge (p<0.001). Both groups had similar distributions of gender and age but group A had a lower proportion of very elderly patients (38 vs. 49%, p=0.048). Group A had more patients with CSI ≥8 points (64 vs. 32%, p<0.001), arterial hypertension (84 vs. 62%, p<0.001), stroke (19 vs. 9%, p=0.009), hemiplegia (7 vs. 2%, p=0.036), hyperlipidemia (45 vs. 25%, p<0.001), dementia (16 vs 7%, p=0.01), chronic obstructive pulmonary disease (20 vs 11%, p=0.032), peripheral artery disease (40 vs 15%, p<0.001) and metastatic cancer (7 vs 5%, p=0.041). Regarding initiation of hemodialysis (HD) while hospitalized, there were no differences among both groups (n=82, 63% vs. 110, 59%, p=0.481, respectively). Admission serum albumin, baseline serum creatinine, days in hemodialysis and admission length were not statistically among groups. Out of the 82 diabetic patients who initiated HD, 45 (55%) were dialysis-dependent at discharge and 44 (98%) 30 days after. In Group B, out of 110 dialyzed patients, 58 (53%) were on dialysis at discharge and 50 (86%) remained on dialytic therapy at 30 days. Globally, a total of 16 (20%) patients that started hemodialysis in group A and 35 (32%) in group B died; none recovered renal function. However, during the 30-day period after discharge, group B patients had a higher mortality (7 vs. 2%, p=0.037). CONCLUSIONS: Although diabetic patients had more comorbidities than nondiabetics, it did not affect the rate of progression or probability of being on HD 30 days after discharge, neither it increased the mortality. This may result from a younger population together with a initial phase of diabetic nephropathy or others factors not known.