Community-acquired acute kidney injury (CA-AKI) is the development of AKI outside of the hospital setting and is the most common form of AKI. Much of the research to date on CA-AKI has been limited to episodes during an acute hospitalization (i.e. patients found to have AKI upon admission), which represents only a fraction of the overall CA-AKI burden. Notably, these CA-AKI estimates are largely assessed in studies conducted in integrated health systems outside of the United States (US); such national estimates are lacking in US populations. Despite this scant evidence base, estimates indicate that a majority of CA-AKI events do not result in acute hospitalization, yet outpatient CA-AKI events remain poorly characterized. Regardless of setting, CA-AKI portends a significantly high risk of poor long-term outcomes, including increased risk of hospitalization, poor renal outcomes and death. Moreover, there is a limited evidence that informs the few guidelines directing CA-AKI management, and none delineate the role of the provider in CA-AKI aftercare or outcomes. Through a systematic program of research, the goal of this study is to assess the continuum of CA- AKI through rigorous evaluation of 1) measurement approaches for identifying CA-AKI, 2) CA-AKI clinical outcomes, and 3) risk factors and etiologies for CA-AKI development. This will be accomplished by merging several years of national Veterans Healthcare Administration's laboratory and administrative data with Medicare administrative data to facilitate a national evaluation of CA-AKI development and subsequent clinical consequences. This project has three specific aims:
Aim 1 of this study will describe the epidemiology of CA- AKI, by applying various clinical measurement approaches to define CA-AKI development and describe CA- AKI incidence in the Veterans Health administration, and Aim 2 will assess the risk of adverse clinical outcomes including hospitalization or death associated with CA-AKI development. Building from this work, Aim 3 will classify the most common clinical types of CA-AKI among veterans with identified CA-AKI. Our approach is innovative because it will be the first study to: (1) use national datasets to comprehensively examine outpatient-based CA-AKI outcomes in a US population cohort and (2) identify the most common types of CA- AKI which will inform tailored CA-AKI risk stratification. This project will identify areas for improving care standards for prevention and clinical management of CA-AKI, provide a critically needed empirical basis to refine clinical guidelines, and inform the development of future, targeted interventions designed to improve the clinical management of CA-AKI and related morbidity and mortality.
The proposed research is relevant to public health because the use of innovative and rigorous research strategies will generate findings that will expand the existing knowledge base on the measurement and burden of, and risk factors for community-acquired acute kidney injury (CA-AKI) in the United States. As such, results from this work will inform the development of AKI guidelines and management strategies to improve the risk of adverse clinical outcomes in high risk outpatient populations. Thus, the proposed research is relevant to the parts of NIH's mission to disseminate science-based information on kidney conditions to improve people's health and quality of life.