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Current acute kidney injury (AKI) diagnostic criteria are restricted to the inpatient setting. We proposed a new AKI diagnostic algorithm for the outpatient setting and evaluate whether outpatient AKI (AKI OPT ) modifies the disease course among patients with chronic kidney disease (CKD) enrolled in the national predialysis registry. AKI OPT  was detected when a 50% increase in serum creatinine level or 35% decline in eGFR was observed in the 180-day period prior to enrollment in the predialysis care program. Outcomes were progression to end-stage renal disease (ESRD) and all-cause mortality. Association analyses were performed using multiple Cox regression and coarsened exact matching (CEM) analysis. Among 6,046 patients, 31.5% (1,905 patients) had developed AKI OPT  within the 180-day period before enrollment. The adjusted hazard ratios of the 1-year and overall risk of ESRD among patients with preceding AKI OPT  compared with those without AKI OPT  were 2.61 (95% CI: 2.15–3.18) and 1.97 (1.72–2.26), respectively. For 1-year and overall risk of all-cause mortality, patients with AKI OPT  had respectively a 141% (95% CI: 89–209%) and 84% (56–117%) higher risk than those without AKI OPT . This statistical inference remained robust in CEM analysis. We also discovered a complete reversal in the eGFR slope before and after the AKI OPT  from −10.61 ± 0.32 to 0.25 ± 0.30 mL/min/1.73 m 2  per year; however, the loss of kidney function is not recovered. The new AKI OPT  diagnostic algorithm provides prognostic insight in patients with CKD.

Acute Kidney Injury in the Outpatient Setting Associates with Risk of End-Stage Renal Disease and Death in Patients with CKD