Abstract
This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.
Highlights
Most studies of severe acute kidney injury (AKI) in the critically ill have focused on short-term outcomes often assessed at hospital discharge
Several patient-level susceptibilities modify the likelihood of nonrecovery from AKI and rapid progression to end stage renal disease (ESRD), in particular older age,[36,37,38] severity of chronic kidney (CKD) at baseline, female sex, presence of co-morbidities, parenchymal etiology of AKI, and late initiation of renal replacement therapy (RRT) or use of conventional intermittent RRT have all been associated with reduced recovery[5,8,21,25,38,39,40,41,42,43] (Table 2)
AKI is an independent risk for incident CKD and progression to ESRD44-47 and the severity of AKI has been associated with recovery of renal function at the time of hospital discharge and progression to CKD
Summary
Most studies of severe acute kidney injury (AKI) in the critically ill have focused on short-term outcomes often assessed at hospital discharge. At 6 months, the cumulative mortality has been reported between 55 and 73%.7-9 In a large retrospective study, Morgera et al.[10] reported the long-term outcomes in a cohort of critically ill patients with severe AKI requiring RRT.
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