Kidney function decline after a non-dialysis-requiring acute kidney injury is associated with higher long-term mortality in critically ill survivors

biomed - Lai Chun-Fu , Wu Vin-Cent , Huang Tao-Min , Yeh Yu-Chang , Wang Kuo-Chuan , Han Yin-Yi , Lin Yu-Feng , Jhuang Ying-Jheng , Chao Chia-Ter , Shiao Chih-Chung , Tsai Pi-Ru , Hu Fu-Chang , Chou Nai-Kuan , Ko Wen-Je , Wu Kwan-Dun , The

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The adverse consequences of a non-dialysis-requiring acute kidney injury (AKI) are unclear. This study aimed to assess the long-term prognoses for critically ill patients experiencing a non-dialysis-requiring AKI. Methods This retrospective observational cohort study investigated non-dialysis-requiring AKI survivors in surgical intensive care units between January 2002 and June 2010. All longitudinal post-discharge serum creatinine measurements and information regarding end-stage renal disease (ESRD) and death were collected. We assessed the long-term outcomes of chronic kidney disease (CKD), ESRD and all-cause mortality beyond discharge. Results Of the 922 identified critically ill patients with a non-dialysis-requiring AKI, 634 (68.8%) patients who survived to discharge were enrolled. A total of 207 patients died after a median follow-up of 700.5 days. The median intervals between the onset of the AKI and the composite endpoints "stage 3 CKD or death", "stage 4 CKD or death", "stage 5 CKD or death", and "ESRD or death" were 685, 1319, 1743, and 2048 days, respectively. This finding shows a steady long-term decline in kidney function after discharge. Using the multivariate Cox proportional hazard model, we found that every 1 mL/min/1.73 m 2 decrease from baseline estimated glomerular filtration rate (eGFR) of individuals who progressed to stage 3, 4, and 5 CKD increased the risks of long-term mortality by 0.7%, 2.3%, and 4.1%, respectively (all p < 0.05). This result indicates that the mortality risk increased significantly in a graded manner as kidney function declined from the baseline eGFR to advanced stages of CKD during the follow-up period. Conclusions In critically ill patients who survive a non-dialysis-requiring AKI, there is a need for continuous monitoring and kidney function protection beyond discharge.

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Publié par	biomed
Publié le	01 janvier 2012
Nombre de lectures	7
Langue	English

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Laiet al.Critical Care2012,16:R123 http://ccforum.com/content/16/4/R123

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Open Access

Kidney function decline after a nondialysis requiring acute kidney injury is associated with higher longterm mortality in critically ill survivors 1 1 2 3 4 4,5 1,5 ChunFu Lai , VinCent Wu , TaoMin Huang , YuChang Yeh , KuoChuan Wang , YinYi Han , YuFeng Lin , 1 1 6 4,5 7 4 3,4* YingJheng Jhuang , ChiaTer Chao , ChihChung Shiao , PiRu Tsai , FuChang Hu , NaiKuan Chou , WenJe Ko 1* and KwanDun Wu , on behalf of the National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF)

Abstract Introduction:The adverse consequences of a nondialysisrequiring acute kidney injury (AKI) are unclear. This study aimed to assess the longterm prognoses for critically ill patients experiencing a nondialysisrequiring AKI. Methods:This retrospective observational cohort study investigated nondialysisrequiring AKI survivors in surgical intensive care units between January 2002 and June 2010. All longitudinal postdischarge serum creatinine measurements and information regarding endstage renal disease (ESRD) and death were collected. We assessed the longterm outcomes of chronic kidney disease (CKD), ESRD and allcause mortality beyond discharge. Results:Of the 922 identified critically ill patients with a nondialysisrequiring AKI, 634 (68.8%) patients who survived to discharge were enrolled. A total of 207 patients died after a median followup of 700.5 days. The median intervals between the onset of the AKI and the composite endpoints“stage 3 CKD or death”,“stage 4 CKD or death”,“stage 5 CKD or death”, and“ESRD or death”were 685, 1319, 1743, and 2048 days, respectively. This finding shows a steady longterm decline in kidney function after discharge. Using the multivariate Cox proportional hazard model, we found 2 that every 1 mL/min/1.73 m decrease from baseline estimated glomerular filtration rate (eGFR) of individuals who progressed to stage 3, 4, and 5 CKD increased the risks of longterm mortality by 0.7%, 2.3%, and 4.1%, respectively (all p< 0.05). This result indicates that the mortality risk increased significantly in a graded manner as kidney function declined from the baseline eGFR to advanced stages of CKD during the followup period. Conclusions:In critically ill patients who survive a nondialysisrequiring AKI, there is a need for continuous monitoring and kidney function protection beyond discharge.

Introduction Acute kidney injury (AKI) is a major contributor to mor bidity and mortality in hospitalized patients [1]. Epidemio logical studies have found that there is a gradual increase in the incidence of AKI no matter whether or not the patient requires dialysis [24]. Although many studies on patients with AKI who require dialysis have been

* Correspondence: kowj@ntu.edu.tw; kdwu@ntuh.gov.tw 1 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan S Rd, Taipei 100, Taiwan 3 Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan S Rd, Taipei 100, Taiwan Full list of author information is available at the end of the article

performed, the literature is rather limited regarding AKI patients who do not require dialysis. Recent reports have indicated that even the smallest changes in serum creati nine (SCr) pose a significant risk for adverse outcomes in AKI patients [5,6]. AKI that does not require dialysis may be of equal or greater importance from a public health perspective than severe AKI requiring dialysis [7]. In addi tion to disease severity, some AKI patients do not receive dialysis due to physician or patient preferences [3]. Thus, further clinical research is warranted focusing on AKI patients who do not receive dialysis. The shortterm adverse consequences of AKI during acute hospital admission have been well defined [1]. Whereas the longterm risks of endstage renal disease

© 2012 Lai et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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