SUN-176 THE LONG-TERM OUTCOMES OF ACUTE KIDNEY INJURY SURVIVORS FROM ICU IN RESOURCE-LIMITED AREA: RESULT FROM SEA-AKI STUDY

Abstract

Acute kidney injury (AKI) is a common condition that leading to high morbidity and mortality during intensive care unit (ICU) admission. However, long-term patient outcomes with AKI in limited-resource countries remains poorly understood. This prospective multicenter observational study was conducted at 5 participating hospitals across Thailand during February 2013 to August 2017. All adult patients (age >15) without prior end-stage renal disease (ESRD) who survived until ICU discharge were included. Clinical data were collected using web-based case record form. For long-term outcomes, we searched the government administration database and Thailand Dialysis Registry using Thai 13-digit identification number to identify survival and dialysis status. The primary outcome was the composite outcome of all-cause mortality and dialysis dependence rate within 2-years after ICU admission, and the secondary outcomes were all-cause mortality and the dialysis dependence rate at 2 years. Survival data was visualized using the Kaplan-Meier plot, and multivariate Cox regression analysis was used to estimate adjusted hazard ratio (AHR) with 95% confidence interval (95% CI) of survival for the other clinical parameters. Of the 1,730 patients who survived until ICU discharge, 617 (35.7%) had AKI, with stages 1, 2, and 3 of 6.4%, 12.3% and 17.0%, respectively. With a median follow up time of 28.5 months, incidence of the primary composite outcome in AKI group was significantly higher than the non-AKI group (51.7% vs. 34.9%, p < 0.01.) In the multivariable cox regression adjusted for potentially confounding clinical parameters, diagnosis, and comorbidities, patients with AKI had a higher risk for 2-year composite outcome of death and dialysis dependence relative to patients without AKI (AHR 1.27; 95%CI: 1.07-1.52, p<0.01). Importantly, the mortality risk increased by AKI stages with AHRs (95% CI) were 1.31 (95%CI: 1.04-1.65) and 1.44 (95%CI: 1.13-1.84) for AKI stage 2 and 3, P = 0.02 and <0.01, respectively. Despite survival to ICU discharge, patients who had AKI still had a higher risk of long-term mortality and dialysis dependence relative to patients who did not have AKI, particularly, those with more severe stage of AKI. Therefore, follow up of patients with severe AKI after hospital discharge is essential.