Risk of incident bleeding after acute kidney injury: A retrospective cohort study.

Abstract Purpose End-stage kidney disease (ESKD) causes bleeding diathesis; however, whether these findings are extrapolable to acute kidney injury (AKI) remains uncertain. We assessed whether AKI is associated with an increased risk of bleeding. Methods Single-center retrospective cohort study, excluding readmissions, admissions Results In 1001 patients, bleeding occurred in 48% of AKI and 57% of non-AKI patients (p = .007). To identify predictors of incident bleeding, we excluded patients who bled before ICU (n = 488). In bleeding-free patients (n = 513), we observed a trend toward higher risks of bleeding in AKI (22% vs. 16%, p = .06), and a higher risk of bleeding in AKI-requiring dialysis (38% vs. 17%, p = .01). Cirrhosis, AKI-requiring dialysis, anticoagulation, and coronary artery disease were associated with bleeding (HR 3.67, 95%CI:1.33–10.25; HR 2.82, 95%CI:1.26–6.32; HR 2.34, 95%CI:1.45–3.80; and HR 1.84, 95%CI:1.06–3.20, respectively), while SOFA score and sepsis had a protective association (HR 0.92 95%CI:0.84–0.99 and HR 0.55, 95%CI:0.34–0.91, respectively). Incident bleeding was not associated with mortality. Conclusions AKI-requiring dialysis was associated with incident bleeding, independent of anticoagulant administration. Studies are needed to better understand how AKI affects coagulation and clinical outcomes.