Acute kidney disease and long-term outcomes in critically ill acute kidney injury patients with sepsis: a cohort analysis

Abstract

Background Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse short- and long-term consequences. Acute kidney disease (AKD) reflects the continuing pathological processes and adverse events developing after AKI. We aimed to evaluate the association of AKD, long-term adverse renal function and mortality in a cohort of patients with sepsis. Methods We performed a retrospective analysis of adult patients with septic AKI admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Patients were categorized according to the development of AKI using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. AKD was defined as presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. Results From 256 selected patients with septic AKI, 53.9% developed AKD. The 30-day mortality rate was 24.5% (n = 55). The mean long-term follow-up was 45.9 ± 43.3 months. The majority of patients experience an adverse renal outcome [n = 158 (61.7%)] and 44.1% (n = 113) of patients died during follow-up. Adverse renal outcomes, 30-day mortality and long-term mortality after hospital discharge were more frequent among AKD patients [77.5 versus 43.2% (P < 0.001), 34.1 versus 6.8% (P < 0.001) and 64.8 versus 49.1% (P = 0.025), respectively]. The 5-year cumulative probability of survival was 23.2% for AKD patients, while it was 47.5% for patients with no AKD (log-rank test, P < 0.0001). In multivariate analysis, AKD was independently associated with adverse renal outcomes {adjusted hazard ratio [HR] 2.87 [95% confidence interval (CI) 2.0–4.1]; P < 0.001} and long-term mortality [adjusted HR 1.51 (95% CI 1.0–2.2); P = 0.040]. Conclusions AKD after septic AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge.

Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

“…Xiao et al [ 39 ] also demonstrated AKD was independently associated with increased 90-day mortality in hospitalized AKI patients. Gameiro et al [ 40 ] reported that AKD after AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge in a population of 256 septic AKI patients admitted to an ICU.…”

Artificial Intelligence for Risk Prediction of End-Stage Renal Disease in Sepsis Survivors with Chronic Kidney Disease

“…Joana et al conducted a retrospective cohort study of 256 critically ill patients with sepsisassociated AKI to evaluate their risk of adverse renal outcomes after surviving sepsis. Post-discharge 30-day and long-term mortality rates were 21.4% and 44.1%, respectively, whereas the percentage of patients requiring long-term dialysis was 16.5% during followup [24]. Moreover, Hallie et al indicated that survivors of severe sepsis had a higher re-hospitalization rate of 42.7% for sepsis relapse and AKI compared with comorbiditymatched patients without sepsis [25].…”

Association Between Base Excess and Mortality Among Patients in ICU with Acute Kidney Injury

“…Author details 1 Department of military health statistics, Naval Medical University, shanghai, China 2 Department of Clinical Pharmacy, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.…”

“…Acute kidney injury (AKI) could be considered as a severe complication in intensive care unit (ICU), as its association with higher morbidity, higher mortality and poorer outcomes. The incidence of AKI ranges from 2% in the community setting to 20% in hospitalized patients, and even up to 60% in ICU 1 .…”