Supplementary Material for: Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

Background: Acute kidney injury (AKI) is associated with increased morbidity and mortality. Mortality in end-stage renal disease (ESRD) patients is highest during the first year of dialysis. The impact of pre-ESRD AKI events on long-term outcomes in incident ESRD patients remains unknown. Methods: We evaluated a retrospective cohort of 47,341 incident hemodialysis patients from the United States Renal Data System with linked Medicare data for at least 2 years prior to hemodialysis initiation. We examined the impact of pre-ESRD AKI events in the 2-year pre-ESRD period on the type of vascular access used at hemodialysis initiation (central venous catheter (CVC) versus arteriovenous access), and 1-year all-cause mortality after initiating hemodialysis. Results: The mean age was 72 ± 11 years. Of the study cohort, 18% initiated hemodialysis with arteriovenous access, and 54% of patients had at least one pre-ESRD AKI event. One-year, all-cause mortality was 32%. Compared to 75% for patients without a pre-ESRD AKI event, 89% of patients with a pre-ESRD AKI event initiated hemodialysis with CVC than arteriovenous access (p p p Conclusion: An AKI event prior to initiating hemodialysis independently increases the risk of CVC use and predicts 1-year mortality. Improving processes of care after AKI events may improve dialysis outcomes in patients who progress to ESRD.## 背景 急性肾损伤（Acute kidney injury, AKI）与发病率及死亡率升高密切相关。终末期肾病（End-stage renal disease, ESRD）患者的死亡率在透析起始后的第一年达到峰值。透析前AKI事件对新发ESRD患者长期预后的影响目前仍不明确。 ## 方法 本研究针对美国肾脏数据系统（United States Renal Data System）收录的47341例新发血液透析患者构建回顾性队列，所有患者在血液透析启动前均拥有至少2年的联邦医疗保险（Medicare）关联数据。本研究探讨了ESRD前2年内发生的AKI事件对血液透析启动时血管通路类型（中心静脉导管（central venous catheter, CVC）与动静脉通路）的影响，以及血液透析启动后1年内的全因死亡率。 ## 结果 研究队列的平均年龄为72±11岁。本队列中18%的患者以动静脉通路启动血液透析，54%的患者至少发生过1次ESRD前AKI事件。1年全因死亡率为32%。与未发生ESRD前AKI事件的患者（75%采用动静脉通路）相比，发生过ESRD前AKI事件的患者中，有89%采用中心静脉导管而非动静脉通路启动血液透析（p p p）。 ## 结论 血液透析启动前发生AKI事件会独立增加中心静脉导管的使用风险，并可预测1年全因死亡率。在AKI事件发生后优化临床诊疗流程，或可改善进展至ESRD的患者的透析预后。