SP393ACUTE KIDNEY INJURY EPISODES IN DIABETES MELLITUS: A RETROSPECTIVE COHORT ANALYSIS

Abstract

Introduction and Aims: Acute kidney injury (AKI) is a heterogeneous syndrome. Recent epidemiological studies demonstrate the wide variation in etiologies and risk factors, describe the increased mortality associated with this disease (particularly when dialysis is required), and suggest a relationship to the subsequent development of chronic kidney disease (CKD) and progression to dialysis dependency. Little is known about the long-term outcome of AKI in diabetes. Goal: To assess AKI prognosis factors in diabetic patients, measured by AKIN degree at hospital admission, dialysis need, need for an intensive care unit (ICU), dialysis suspension at discharge date, mortality during hospitalization and progression to chronic kidney disease (CKD) 3 months later. Methods: A retrospective observational study of the entire diabetic hospitalized for AKI between January 2011 and September 2015. Demographic, clinical and analytical variables were evaluated and related with the proposed outcomes Results: The study involved 48 patients. The average age was 76.8 ± 9.5 years and 38% (n=18) were male. The mean GFR was 73.2 ± 13.4 mL/min/1,73m2 with a mean diabetes duration of 8.3 ± 6.9 years. All the patients were type 2 diabetic and 95,8% (n=46) had AKIN 3. Of the 48 patients included in this study, 70% (n=34) needed dialysis, 25% (n=12) were admitted in an ICU and 6% (n=3) died during hospitalization. At discharge date 77% (n=37) discontinued dialysis. Three months later 8,3 % (n=4) died, 21% patients (n=10) recovered renal function, while 65% (n=31) progressed to CKD. Independent risk factors for HD's need were metformin-associated lactic acidosis (MALA) [(OR) 11,154 (CI:7,67-33,41) p=0,001)], hospital-acquired AKI [(OR) 5,48 (CI:1,93-13,94) p=0,019)] and haemoglobin levels < 10g/dL [(OR) 4,11 (CI:1,33-9,76) p=0,043)]. The main variable predicting the need of an UCI was the use of intravenous contrast [(OR) 6,18 (CI:5,45-19,32) p=0,013)]. Presence of retinopathy and higher proteinuria levels (>30mg/day) were significantly (p<0.05) associated with maintenance dialysis [(OR) 4,97 (CI:2,91-11,01) and (OR) 6,76 (CI:5,4-2,13), respectively]. In what concerns progression to CKD the following factors showed statistical significance (p<0.05): higher proteinuria levels [(OR) 11,46 (CI:7,42-45,75)], hospital-acquired AKI [(OR) 8,32 (CI:2,93-19,4)], hypotension on admission [(OR) 8,32 (CI:2,93-19,4)] and patients who underwent a biopsy [(OR) 36,8 (CI:22,3-124,9)]. There were no independent risk factor for mortality and AKIN degree. Conclusions: Diabetes grants an increased risk for the development of AKI. In our cohort the worse prognostic factors were evidence of target organ damage, hospital-acquired AKI, hypotension and MALA.