Mortality Prediction in Patients with Severe Acute Kidney Injury Requiring Renal Replacement Therapy.

Žilvinas Paškevičius,Inga Skarupskienė,Eglė Dalinkevičienė,Vilma Balčiuvienė,Kristina Petrulienė,Neda Kušleikaitė-Pere,Edita Žiginskienė

doi:10.3390/medicina57101076

Žilvinas Paškevičius, Inga Skarupskienė + Show 5 more

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https://doi.org/10.3390/medicina57101076

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Abstract

Background and Objective: Acute kidney injury (AKI) remains a serious health condition around the world, and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes. The aim of our study was to estimate the significant related factors for poor outcomes of patients with severe AKI requiring renal replacement therapy (RRT). Materials and Methods: We retrospectively analyzed data from patients (n = 573) with severe AKI requiring RRT within a 5-year period and analyzed the outcomes on discharge from the hospital. We also compared the clinical data of the surviving and non-surviving patients and examined possible related factors for poor patient outcomes. Logistic regression was used to analyze the odds ratio for patient mortality and its related factors. Results: In 32.5% (n = 186) of the patients, the renal function improved and RRT was stopped, 51.7% (n = 296) of the patients died, and 15.9% (n = 91) of the patients remained dialysis-dependent on the day of discharge from the hospital. During the period of 5 years, the outcomes of the investigated patients did not change statistically significantly. Administration of vasopressors, aminoglycosides, sepsis, pulmonary edema, oliguria, artificial pulmonary ventilation (APV), patient age ≥ 65 y, renal cause of AKI, AKI after cardiac surgery, a combination of two or more RRT methods, dysfunction of three or more organs, systolic blood pressure (BP) ≤ 120 mmHg, diastolic BP ≤ 65 mmHg, and Sequential Organ Failure Assessment (SOFA) score on the day of the first RRT procedure ≥ 7.5 were related factors for lethal patient outcome. Conclusions: The mortality rate among patients with severe AKI requiring RRT is very high—52%. Patient death was significantly predicted by the causes of AKI (sepsis, cardiac surgery), clinical course (oliguria, pulmonary edema, hypotension, acidosis, lesion of other organs) and the need for a continuous renal replacement therapy.

Highlights

For a long time, acute kidney injury (AKI) has been recognized as a severe health disorder
We examined possible related factors for poor patient outcomes: age, arterial hypotension, oliguria, pulmonary edema, administration of vasopressors and aminoglycosides, modality and duration of renal replacement therapy (RRT), sepsis, causes of Acute kidney injury (AKI), Sequential Organ Failure Assessment (SOFA) as an organ failure score, the presence of multiple organ dysfunction syndrome (MODS), and the application of artificial pulmonary ventilation (APV) at the time of the initiation of RRT
The lethal outcome was significantly associated with patient age ≥ 65, systolic blood pressure (BP) ≤ 120 mmHg, multiple organ dysfunction syndrome (≥3-organ dysfunction), a renal cause of AKI, AKI which had developed after cardiac surgery, pH < 7.3, oliguria, and the administration of aminoglycosides and vasopressors

Summary

Introduction

Acute kidney injury (AKI) has been recognized as a severe health disorder. AKI is still frequent around the world and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes, such as chronic kidney disease (CKD) [1,2]. Severe AKI requiring renal replacement therapy (RRT) occurs in 2–7% of all ICU patients [9]. Acute kidney injury (AKI) remains a serious health condition around the world, and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes. The aim of our study was to estimate the significant related factors for poor outcomes of patients with severe AKI requiring renal replacement therapy (RRT). Materials and Methods: We retrospectively analyzed data from patients (n = 573) with severe AKI requiring RRT within a 5-year period and analyzed the outcomes on discharge from the hospital. Patient death was significantly predicted by the causes of AKI (sepsis, cardiac surgery), clinical course (oliguria, pulmonary edema, hypotension, acidosis, lesion of other organs) and the need for a continuous renal replacement therapy

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