Patients admitted to the hospital for pneumonia commonly develop acute kidney injury (AKI). Those who progress to AKI requiring dialysis (AKI-D) face increased risk for adverse outcomes. However, according to Sae X. Morita, MD, and colleagues, there are few data available on the risk factors for AKI-D in patients admitted with pneumonia and chronic kidney disease (CKD).
The researchers conducted an analysis of data from the National Inpatient Sample for 2019 to examine the incidence of AKI-D among patients with CKD hospitalized for pneumonia. Results were reported during a poster session at the National Kidney Foundation Spring Clinical Meetings 2023 in a poster titled Risk Factors for Acute Kidney Injury (AKI) Requiring Dialysis in Patients With and Without Chronic Kidney Disease (CKD) During an Admission for Pneumonia Using a Nationally Representative Sample.
The outcome of interest was AKI-D. Transplant recipients and those receiving maintenance dialysis were excluded. The analysis compared baseline characteristics in the CKD and non-CKD groups. Risk factors for AKI-D were determined using multiple logistic regression in separate models.
The database identified 1,459,854 admissions with a primary diagnosis of pneumonia. Of those, 20% were in patients with CKD. Patients with CKD were older (75.9 vs 63.6 years; P<.01), and less likely to be female (45% vs 50%; P<.01), compared with the non-CKD group. AKI-D was more common in patients with CKD (2.5% vs 0.03%; P<.01). Overall, mortality was 4.8%, and it was higher in the CKD group than in the non-CKD group (6.4% vs 4.4%; P<.01).
In the CKD group, the multivariable model demonstrated an association between younger age, male sex, and Black, Hispanic, and Asian race and higher odds of AKI-D. In addition, admission to a large urban, teaching, privately owned hospital was associated with higher odds of AKI-D.
In conclusion, the researchers said, “The incidence of AKI-D was 10 times higher in the CKD group than in the non-CKD population. Male, Black, Hispanic, and Asian patients and hospital settings such as region and teaching status were risk factors for AKI-D in both groups. Further studies are needed to evaluate whether differences in clinical practice underlie some of these risks.”
Source: Morita SX, Deda X, Melamde M. Risk factors for acute kidney injury (AKI) requiring dialysis in patients with and without chronic kidney disease (CKD) during an admission for pneumonia using a nationally representative sample. Poster #19. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 5-11, 2023; Austin, Texas.