Subgroups of Patients with Distinct Health Utility Profiles after AKI

KEY POINTS: Health utility profiles can be identified at 60 days after AKI. Patient subgroups with distinct health utility profiles have different characteristics at index hospitalization and outcomes at 1 year. These profiles may be useful when considering resources to improve the physical and emotional health of patients after AKI. BACKGROUND: A large amount of interindividual variability exists in health-related quality of life outcomes after AKI. This study aimed to determine whether subgroups of early AKI survivors could be identified on the basis of distinct health utility impairment profiles ascertained at 60 days after AKI and whether these subgroups differed in clinical and biomarker characteristics at index hospitalization and outcomes at 1-year follow-up. METHODS: This retrospective analysis used data from the Biologic Markers of Renal Recovery for the Kidney study, an observational subcohort of the Acute Renal Failure Trial Network study. Of 402 patients who survived to 60 days after AKI, 338 completed the Health Utility Index 3 survey, which measures impairments in eight health attributes. Latent class analysis was used to identify subgroups of patients with distinct health utility profiles. RESULTS: Three subgroups with distinct health utility impairment profiles were identified: Low (28% of participants), Moderate (58%), and High (14%) with a median of one, four, and six impairments across the eight health attributes at 60 days after AKI, respectively. Patient subgroups differed in weight, history of cerebrovascular disease, intensity of dialysis, hospital length of stay, and dialysis dependence. Serum creatinine and blood urea nitrogen at index hospitalization did not differ among the three subgroups. The High impairment subgroup had higher levels of IL-6 and soluble TNF receptor 2 at study day 1. The three subgroups had different 1-year mortality rates: 5% in the Low, 21% in the Moderate, and 52% in the High impairment subgroup. CONCLUSION: Patient subgroups with distinct health utility impairment profiles can be identified 60 days after AKI. These subgroups have different characteristics at index hospitalization. A higher level of impairment at 60 days was associated with decreased survival.