Abstract
BackgroundAcute kidney injury (AKI) commonly occurs in intensive care units (ICUs), leading to adverse clinical outcomes and increasing costs. However, there are limited epidemiological data of AKI in the critically ill in Beijing, China.MethodsIn this prospective cohort study in 30 ICUs, we screened the patients up to 10 days after ICU admission. Characteristics and outcomes were compared between AKI and non-AKI, renal replacement therapy (RRT) and non-RRT patients. Nomograms of logistic regression and Cox regression were performed to examine potential risk factors for AKI and mortality.ResultsA total of 3107 patients were included in the final analysis. The incidence of AKI was 51.0%; stages 1 to 3 accounted for 23.1, 11.8, and 15.7%, respectively. The majority (87.6%) of patients with AKI developed AKI on the first 4 days after admission to the ICU. A total of 281 patients were treated with RRT. Continuous RRT with predilution, citrate for anticoagulation and femoral vein for vascular access was the most common RRT pattern (29.9%, 84 of 281). Patients with AKI were associated with longer ICU-LOS and higher mortality and costs (P<0.001). In patients treated with RRT, 78.6 and 28.5% of RRTs were dependent on the 7th and 28th days, respectively. The 28 day mortalities of non-AKI, AKI stages 1–3, and septic shock patients were 6.83, 15.04, 27.99, 45.18 and 36.5%, respectively.ConclusionsApproximately half of our ICU patients experienced AKI. The majority of patients with AKI developed AKI during the first 4 days after admission to the ICU. Continuous RRT with predilution, citrate for anticoagulation and femoral vein for vascular access was the most common RRT pattern in our ICUs. AKI was associated with a higher mortality and costs, incomplete kidney recovery and s series of adverse outcomes.
Highlights
Acute kidney injury (AKI) commonly occurs in intensive care units (ICUs), leading to adverse clinical outcomes and increasing costs
The logistic regression nomogram indicated that baseline creatinine (OR = 1.00; 95% confidence interval (CI) 1.00–1.01), APACHE Simplified Acute Physiology Score II (II) score (OR = 1.05; 95% CI: 1.04–1.07), sequential organ failure assessment (SOFA) score (OR = 1.16; 95% CI 1.13–1.19), sepsis (OR = 1.88; 95% CI 1.56–2.27) and exposure to nephrotoxic drugs (OR = 1.41; 95% CI 1.19–1.66) might be independent predictors of AKI development (Fig. 3a)
Physicians reported that 296 (33.8%) cases of sepsis contributed to AKI, and 175 (20.0%) cases of sepsis were possibly associated with AKI development
Summary
Acute kidney injury (AKI) commonly occurs in intensive care units (ICUs), leading to adverse clinical outcomes and increasing costs. There are limited epidemiological data of AKI in the critically ill in Beijing, China. Acute kidney injury (AKI) is a life-threatening disease and global health burdens with increasing incidence in both developed and developing countries [1, 2]. AKI commonly occurs in the intensive care unit (ICU), and is caused by multiple risk factors, leading to adverse clinical outcomes, increasing costs, and the development of chronic kidney disease (CKD) [3,4,5,6,7,8]. Beijing to determine the incidence, risk factors, renal replacement therapy (RRT) practice, and the outcome of patients with AKI
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