Abstract
BackgroundIn intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT.MethodsWe conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital. During the study period from August 2004 through December 2012, all consecutive adult patients with AKI-RRT were included. Data were prospectively recorded during the patients’ hospital stay and were retrieved from the hospital databases. Data on long-term follow-up were gathered during follow-up consultation or, in the absence of this, by consulting the general physician.ResultsAKI-RRT was reported in 1292 of 23,665 first ICU admissions (5.5 %). Mortality increased from 59.7 % at hospital discharge to 72.1 % at 3 years. A Cox proportional hazards model demonstrated an association of increasing age, severity of illness, and continuous RRT with long-term mortality. Among hospital survivors with reference creatinine measurements, 1-year renal recovery was complete in 48.4 % and incomplete in 32.6 %. Dialysis dependence was reported in 19.0 % and was associated with age, diabetes, chronic kidney disease (CKD), and oliguria at the time of initiation of RRT. MAKE increased from 83.1 % at hospital discharge to 93.7 % at 3 years. Multivariate regression analysis showed no association of classical determinants of outcome (preexisting CKD, timing of initiation of RRT, and RRT modality) with MAKE at 1 year.ConclusionsOur study demonstrates poor long-term survival after AKI-RRT that was determined mainly by severity of illness and RRT modality at initiation of RRT. Renal recovery is limited, especially in patients with acute-on-chronic kidney disease, making nephrological follow-up imperative. MAKE is associated mainly with variables determining mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1409-z) contains supplementary material, which is available to authorized users.
Highlights
In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-Renal replacement therapy (RRT)) is associated with adverse outcomes
CKD may lower the threshold for developing Acute kidney injury (AKI), and acute-on-chronic kidney disease is associated with adverse outcomes [3,4,5,6,7]
After adjustment for confounding covariates, we found that preexisting kidney disease, initial RRT modality, and timing of initiation of RRT were not associated with major adverse kidney events (MAKE) at 1 year
Summary
In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. AKI treated with renal replacement therapy (AKI-RRT) occurs in approximately 13 % of ICU patients [1, 2]. It is associated with adverse outcomes such as increased length of stay, short- and long-term mortality, and end-stage renal disease (ESRD). There is an abundance of epidemiological data demonstrating that AKI in itself leads to adverse outcomes This is so for the most severe form of AKI, where patients are treated with RRT [4, 5]. AKI can be considered both the cause and the consequence of CKD, and AKI and CKD are considered interconnected and integrated syndromes [6]
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