Abstract
IntroductionDialysis-requiring acute kidney injury (D-AKI) is common among intensive care unit (ICU) patients. However, follow-up data on the risk of end-stage renal disease (ESRD) among these patients remain sparse. We assessed the short-term and long-term risk of ESRD after D-AKI, compared it with the risk in other ICU patients, and examined the risk within subgroups of ICU patients.MethodsWe used population-based medical registries to identify all adult patients admitted to an ICU in Denmark from 2005 through 2010, who survived for 90 days after ICU admission. D-AKI was defined as needing acute dialysis at or after ICU admission. Subsequent ESRD was defined as a need for chronic dialysis for more than 90 days or a kidney transplant. We computed the cumulative ESRD risk for patients with D-AKI and for other ICU patients, taking into account death as a competing risk, and computed hazard ratios (HRs) using a Cox model adjusted for potential confounders.ResultsWe identified 107,937 patients who survived for 90 days after ICU admission. Of these, 3,062 (2.8%) had an episode of D-AKI following ICU admission. The subsequent risk of ESRD up to 180 days after ICU admission was 8.5% for patients with D-AKI, compared with 0.1% for other ICU patients. This corresponds to an adjusted HR of 105.6 (95% confidence interval (CI): 78.1 to 142.9). Among patients who survived 180 days after ICU admission without developing ESRD (n = 103,996), the 181-day to 5-year ESRD risk was 3.8% for patients with D-AKI, compared with 0.3% for other ICU patients, corresponding to an adjusted HR of 6.2 (95% CI: 4.7 to 8.1). During the latter period, the impact of AKI was most pronounced in the youngest patients, aged 15 to 49 years (adjusted HR = 12.8, 95% CI: 6.5 to 25.4) and among patients without preexisting chronic kidney disease (adjusted HR = 11.9, 95% CI: 8.5 to 16.8).ConclusionD-AKI is an important risk factor for ESRD for up to five years after ICU admission.
Highlights
Dialysis-requiring acute kidney injury (D-AKI) is common among intensive care unit (ICU) patients
Risk of end-stage renal disease (ESRD) within 90 to 180 Days Out of the 3,062 ICU patients with D-AKI who survived for 90 days after ICU admission, 260 developed ESRD within 180 days following ICU admission (cumulative risk = 8.5%) compared with 57 patients out of 104,875 other ICU patients
This corresponds to an unadjusted hazard ratio (HR) for ESRD of 165.9 for D-AKI patients compared with other ICU patients
Summary
Dialysis-requiring acute kidney injury (D-AKI) is common among intensive care unit (ICU) patients. Follow-up data on the risk of end-stage renal disease (ESRD) among these patients remain sparse. We assessed the short-term and long-term risk of ESRD after D-AKI, compared it with the risk in other ICU patients, and examined the risk within subgroups of ICU patients. End-stage renal disease (ESRD), including need for chronic dialysis or kidney transplantation, is associated with considerable costs and impaired quality of life [7]. Knowledge of the long-term risk of ESRD after D-AKI in ICU patients, both overall and within subgroups, remains sparse, especially for patients who regain sufficient renal function to discontinue dialysis after an episode of D-AKI
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