Sepsis-Associated Acute Kidney Disease Incidence, Trajectory, and Outcomes

Area of Science:

• Nephrology
• Critical Care Medicine
• Epidemiology

Background:

• Sepsis-associated acute kidney disease (SA-AKD) prognosis using real-world data is understudied.
• Electronic health records (EHRs) offer potential for tracing SA-AKD trajectories from acute kidney injury (AKI) to chronic kidney disease (CKD).

Purpose of the Study:

• To utilize data algorithms on EHRs to analyze the prognosis of SA-AKD.
• To track the progression of SA-AKD from AKI to CKD in adult sepsis survivors.

Main Methods:

• Retrospective cohort study of adult inpatients with sepsis.
• Defined SA-AKD based on sustained creatinine increase or kidney replacement therapy initiation post-AKI.
• Classified SA-AKD into recovery, relapse, and persistent subgroups using multivariable Cox proportional hazards models.

Main Results:

• 17.6% of sepsis patients developed SA-AKD; 43.6% recovered, 8.3% relapsed, 32.2% had persistent SA-AKD.
• Relapse and persistent SA-AKD subgroups showed significantly higher 1-year mortality risk compared to recovery.
• Increased risks of kidney replacement therapy (KRT) and de novo non-dialysis dependent CKD (CKD-ND) were observed in non-recovery SA-AKD subgroups.

Conclusions:

• SA-AKD without recovery is linked to elevated long-term risks of KRT initiation and mortality.
• Patients with SA-AKD face an increased risk of developing de novo CKD-ND.
• Further research is needed to optimize management strategies for AKI to AKD to CKD transitions in real-world settings.