OBJECTIVES : Chronic Kidney Disease (CKD) is a condition characterized by a gradual loss of kidney function over time which can lead to kidney failure. Adults with chronic comorbidities like diabetes and/or hypertension are at a high risk of developing CKD. In addition, patients suffering from acute conditions like Acute Kidney Injury (AKI) are also at risk for CKD. The main objective of the present study was to identify patients in different CKD stages, assess risk factors, and explore the relationship between AKI and CKD.

METHODS : This retrospective study examined data from a U.S. electronic health record database (Cerner Health Facts®). All inpatients (≥ 18 years) between 2009 and 2016, with an ICD9/10 diagnosis of CKD, were evaluated in this study. Hypertension and diabetes were identified using ICD9/10 diagnosis codes within Elixhauser Comorbidities. AKI stages were based on KDIGO guidelines and were evaluated using time-stamped laboratory results.

RESULTS : The study included 878,048 patients (51.1% male) with CKD, 61% of patients over 65 years of age. By race, 72.4% of patients were Caucasian, followed by African-American (17.0%). In patients where CKD stages were available (N=447,744), most were in stage 3 (65.5%), followed by 14.6% in stage 4. CKD was diagnosed in 13.6%, 18.1%, and 24.8% of patients with hypertension (N=5,751,488), diabetes (N=2,528,992), and a combination of hypertension and diabetes (N=1,760,992), respectively. Thirty-four percent of all AKI patients had some form of CKD. Patients with AKI stage 3 were more likely to be in stage 5 CKD (5.6%) as compared to AKI stage 2 (0.3%) and AKI stage 1 (0.9%) patients.

CONCLUSIONS : This real-world analysis confirms that patients with chronic comorbidities, such as hypertension and/or diabetes, are at higher risk for CKD. This analysis also demonstrates the interconnected relationship CKD has with AKI.