The prevalence of elevated creatinine and hospital-acquired acute kidney injury in dogs presenting to a veterinary academic medical center between October 2010 - October 2014.
Babyak, Jonathan.
2016
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Abstract: The
impact of acute kidney injury (AKI) and chronic kidney disease (CKD) in dogs has not
been studied, however, AKI and CKD in people are associated with poor outcomes. The
pathophysiology of kidney disease is analogous in people and dogs. Kidney disease in
dogs, however, is complicated by variable care processes, which result in high morbidity
and mortality in this species as well. ... read moreDespite this high burden of poor outcomes, the
epidemiology of markers of kidney disease like creatinine has not been described in
dogs. Similarly, the incidence of hospital acquired acute kidney injury (using Acute
Kidney Injury Network criteria or AKIN) is also not well described in a general
population of hospitalized dogs. In order to better understand kidney disease in dogs,
we estimated the prevalence of elevated creatinine and the incidence of hospital
acquired acute kidney injury at a tertiary care facility, the Henry and Lois Foster's
Hospital for Small Animals (FHSA). We developed a retrospective cross-sectional dataset
of 115,631 hospital visits of all dogs presenting to the Tufts Foster Hospital for Small
Animals from October 2010 to October 2014. We identified dogs that had serum creatinine
evaluation in either the inpatient or outpatient setting. Elevated creatinine was
defined as a serum creatinine >1.6 mg/dL and severely elevated as a serum creatinine
>2.5 mg/dL based on International Renal Interest Society guidelines (IRIS AKI). In
further analyses focusing specifically on inpatient dogs with at least 2 creatinine
measurements, we constructed a retrospective observational cohort for evaluating
hospital acquired acute kidney injury, defined using AKIN criteria that are used in
people The incidence and relative risk of AKIN stages 1, 2 and 3 AKI were calculated.
Subsequent creatinine and AKI analyses evaluated the association between age, sex/neuter
status, creatinine measurement methodology, and first creatinine measurement with
elevated creatinine and hospital acquired AKI, as appropriate. Of the 115,631 visits
during the study period, 98,693 visits were outpatient and 16,938 were hospital
admissions. Ten and one-tenth percent (N=9,983) of outpatients were evaluated for
elevated creatinine; 60.0% (N=10,228) of hospital admissions had at least one
creatinine, and 3,321 met the criteria for retrospective screening of hospital acquired
AKI. The prevalence of elevated creatinine in all evaluated dogs was 11.5% (95% CI:
11.0%, 11.9%); 10.2% (95% CI: 9.6%, 10.8%) of inpatients and 12.9% (95% CI: 12.1%,
13.8%) of outpatients had elevated creatinine. The relative risk (RR) of elevated
creatinine was significantly elevated in geriatric dogs (outpatient RR 1.45 95% CI:
1.23, 1.70; inpatient RR 1.43 95% CI: 1.16, 1.76) and lower in young dogs (outpatient RR
0.39 95% CI: 0.26, 0.59; inpatient RR 0.44 95% CI: 0.32, 0.62) compared to other age
groups; there was no association between sex/neuter status and risk of elevated
creatinine. Of the 3,321 hospitalized dogs evaluated for AKI, 323 (10.0%) had Stage 1,
11 (0.3%) had Stage 2, and 64 (2.0%) had Stage 3. In a subgroup analysis, dogs with a
moderately elevated first creatinine were 58% (RR 1.58 95% CI: 1.03, 2.44) more likely
to have the mildest form of AKI (Stage 1) and dogs with severely elevated first
creatinine were 6 times more likely (RR 6.03 95% CI: 1.06, 34.35) to have Stage 3 kidney
injury, compared to dogs with lower measured first creatinine. In a multivariable
analysis, age and sex were not significantly associated with the probability of
developing hospital acquired AKI; however, mild, moderate, and severe categories of
elevated first creatinine (adjusted ORs: mild OR1.47 [95% CI: 1.09, 1.98], moderate OR
1.93 [95% CI: 1.28, 2.88], and severe OR 2.26 [95% CI: 1.65, 3.08]), each additional day
of hospitalization (adjusted OR 1.11 [95% CI: 1.06, 1.15]), and point of care
measurement instead of chemistry laboratory evaluation of creatinine (adjusted OR 0.73
[95% CI: 0.56, 0.96]) were all significant predictors of hospital acquired AKI. In dogs
presenting to a tertiary referral center, the number of dogs with evidence of kidney
injury is high, which may reflect a sick population seen at the FHSA. We found that
geriatric dogs are more likely to have elevated creatinine, consistent with age related
decreases in kidney function. AKI is common among hospitalized dogs, present in at least
1 in every 10 screened dogs, and is likely even higher in some subgroups. Veterinarians
should consider screening for kidney disease in geriatric dogs with supportive history
or exam findings during outpatient visits. Hospital acquired AKI should be considered
with any acute rise in creatinine, particularly in dogs who have elevated creatinine at
hospital admission and who are hospitalized for long periods of time. More study is
needed on both short term and long term outcomes of dogs with prevalent or incident
kidney disease.
Thesis (M.S.)--Tufts University, 2016.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Daniel Weiner.
Committee: Sawkat Anwer, Farzad Noubary, and Claire Sharp.
Keywords: Veterinary science, and Health sciences.read less - ID:
- bn999k73d
- Component ID:
- tufts:20247
- To Cite:
- TARC Citation Guide EndNote
