Clinical Courses of Acute Kidney Injury in Hospitalized Patients: A Multistate Analysis

Reprints will not be available from the author(s). ABSTRACT Objectives: We hypothesize that multistate models are beneficial in analyzing transitions through kidney states and understanding the underlying processes influencing the course of kidney health. Specifically, we aim to quantify longitudinal acute kidney injury (AKI) trajectories and to describe transitions through progressing and recovery states and outcomes among hospitalized patients. Methods: In this large, longitudinal cohort study, 138,449 adult patients admitted to a quaternary care hospital between January 2012 and August 2019 were staged based on Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria as No AKI, Stage 1, Stage 2, Stage 3, and Stage 3 with renal replacement therapy (RRT) AKI for the first 14 days of their hospital stay. We fit and examined multistate models to estimate probability of being in a certain clinical state at a given time after entering each one of the AKI stages. We investigated the effects of age, sex, race, admission comorbidities, and prolonged intensive care unit (ICU) stay on transition rates via Cox proportional hazards regression models. Results: Twenty percent of hospitalized encounters (49,325/246,964) had AKI; among patients with AKI, 66% (n = 32,739) had Stage 1 AKI, 18% (n = 8,670) had Stage 2 AKI, and 17% (n = 7,916) had AKI Stage 3 with or without RRT.