SP187OUTCOME IN NON-CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS (AKI-D): DIFFERENCES BETWEEN REFERRAL PATTERNS

Abstract

Introduction and Aims: Acute Kidney Injury requiring dialysis treatment (AKI-D) has revealed a significant increase of incidence, with more than 400 new cases per million population/year, and two/thirds concerns non-critically ill patients. In these patients few data on mortality are present as well as information on care organization and its impact on outcome. Specialty training and integrated teams, as well as high volume of activity seem to be linked to better hospital outcome. The study hypothesis to investigate was that mortality of patients admitted and in-care to Nephrology could be lower than in other Medicine Wards. Methods: Propensity Score matched 1:1 prospective study conducted from 2007 to 2014 in a University Hospital. Propensity Score matching considered Framingham Risk Factors, causes of AKI, infections, RIFLE and SAPS2 score. Inclusion and exclusion criteria were defined to avoid possible bias on the cause of hospital admittance and comorbidities. Results: In the period 654 non critically ill patients were observed and 303 fulfilled inclusion/exclusion criteria. Propensity Score matching resulted in two groups: 100 pts in-care to Nephrology (NEPHROpts), and 100 pts to Medicine (MEDpts). Their characteristics, comorbidities, causes of AKI, RIFLE and SAPS2 were similar. Mortality was 36.5%, and a difference was reported between NEPHROpts and MEDpts (21% vs 52%, χ2 = 20.7, p < 0.001). Patients who died differed on age, serum Creatinine, Blood Urea Nitrogen/s. Creatinine ratio, URR, Saps2 score, and Charlson score; they presented a higher rate of Heart Disease, and required in a larger proportion noradrenaline/dopamine for shock. After correction for mortality risk factors, the multivariate Cox analysis revealed that site of treatment corresponding to Medicine represents an independent risk factor of mortality (RR = 2.31; 95% IC = 1.25, 3.63; p < 0.01). Other independent risk factors were hemodialysis Urea Reduction Rate (URR), s. Creatinine at the moment of HD beginning, and SAPS2 score. Conclusions: In our contest we have documented that non-critically ill AKI-D patients, who represent two-third of the population, have high in-hospital mortality (about 36%), and that the site of treatment, a specialist Nephrology team instead of a general Medicine team seems to guarantee a better outcome. The reasons are not investigated, but the significance in health care system organization and resource allocation seems to be important. (Table presented).