Association of persistent acute kidney injury and renal recovery with mortality in hospitalised patients

Ozrazgat‐Baslanti, Tezcan; Loftus, Tyler J.; Ren, Yuanfang; Adıyeke, Esra; Miao, Shunshun; Hashemighouchani, Haleh; Islam, Rubab Tarannum; Mohandas, Rajesh; Gopal, Saraswathi; Shenkman, Louis; Pardalos, Pãnos M.; Brumback, Babette; Segal, Mark S.

doi:10.1136/bmjhci-2021-100458

Cited by 27 publications

(20 citation statements)

References 27 publications

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“…To include also lower stage AKI is relevant. Hoste et al found an odds ratio above two for mortality relative to non‐AKI in the KDIGO group 1 patients, 5 and similar results have been shown also by others as well as in our study 18,19 . Whether these relationships indicate that AKI is a cause for increased mortality or that there is a shared cause for both AKI and increased mortality is unknown.…”

Section: Discussionsupporting

confidence: 86%

“…Hoste et al found an odds ratio above two for mortality relative to non-AKI in the KDIGO group 1 patients, 5 and similar results have been shown also by others as well as in our study. 18,19 Regarding risk factors for developing AKI, we observed a correlation between a lower blood pressure expressed by TAMAP and the development of AKI, and a correlation between the hypotensive dose, described as TWA-MAP<73, and the incidence of AKI, showing significantly more AKI in those having a higher dose of hypotension. Our results are comparable to a UK study, which found that a perfusion pressure of less than 60 mmHg was associated with a progression of AKI.…”

Section: Discussionmentioning

confidence: 73%

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Acute kidney injury in intensive care patients: Incidence, time course, and risk factors

Bjelland

Nilsen

et al. 2022

Acta Anaesthesiol Scand

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Background Acute kidney injury (AKI) is frequent and influences the prognosis of intensive care unit (ICU) patients. The aim of this study was to estimate the incidence, time‐course, risk factors, and mortality of AKI among unselected ICU patients. Methods All adult ICU patients admitted to the ICU at the University Hospital in Central Norway from 2010 to 2015 with a stay of 24 h or more were included in the study. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. All patients were followed with respect to reversal of AKI. Risk factors for AKI were analyzed using Cox regression. Results Among 2325 ICU patients, 1245 developed AKI during the ICU stay, corresponding to an incidence of 53.5 % (CI, 51.5–55.5). The incidence according to KDIGO AKI stages 1, 2, and 3 was 26.2, 11.7, and 15.7%, respectively. The median duration of AKI was 24 (CI 19–24), 32 (CI 26–39), and 101 (CI 75–164) hours for AKI KDIGO stage 1, 2, and 3, respectively. AKI was transient, persistent, or AKD in 73.4, 16.5, and 10.0% of the patients with a known outcome. AKI reversal was observed in 72.9% of all AKI patients. Independent risk factors for AKI in a multivariate analysis were hypertension, diabetes, heart disease, and higher body weight. Episodes of mean arterial pressure below 73 mmHg were associated with a higher risk of AKI. Conclusions In our material, the incidence of AKI was comparable to what has been reported previously. Risk factors for the development of AKI were a MAP below 73, hypertension, diabetes, heart disease, chronic kidney disease, and higher body weight. Most AKI patients regain their kidney function during the ICU stay, particularly in the KDIGO AKI stages 1 and 2.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 73%

Acute kidney injury in intensive care patients: Incidence, time course, and risk factors

Bjelland

Nilsen

et al. 2022

Acta Anaesthesiol Scand

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“…Bhatraju et al found that recovering within the first 72 h immediately following the AKI episode may be crucial to avoid major adverse kidney events [44]. Compared to a rapid reversal (within 48 h), persistent AKI was also significantly associated with a higher 1-year mortality rate [45]. Recovery timing therefore appears to be a major factor in the context of AKI recovery, which adds important prognostic information regarding adverse long-term outcomes following an AKI episode.…”

Section: Discussionmentioning

confidence: 99%

Patient outcomes following AKI and AKD: a population-based cohort study

Wang

Lambourg

Guthrie

et al. 2022

BMC Med

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Background Acute kidney injury (AKI) is common and associated with adverse outcomes as well as important healthcare costs. However, evidence examining the epidemiology of acute kidney disease (AKD)—recently defined as AKI persisting between 7 and 90 days—remains limited. The aims of this study were to establish the rates of early AKI recovery, progression to AKD and non-recovery; examine risk factors associated with non-recovery and investigate the association between recovery timing and adverse outcomes, in a population-based cohort. Methods All adult residents of Tayside & Fife, Scotland, UK, with at least one episode of community or hospital-managed AKI using KDIGO creatinine-based definition during the period 1 January 2010 to 31 December 2018 were identified. Logistic regression was used to examine factors associated with non-recovery, and Cox modelling was used to establish associations between AKI recovery timing and risks of mortality and development of de novo CKD. Results Over 9 years, 56,906 patients with at least one AKI episode were identified with 18,773 (33%) of these progressing to AKD. Of those progressing to AKD, 5059 (27%) had still not recovered at day 90 post AKI diagnosis. Risk factors for AKD included: increasing AKI severity, pre-existing cancer or chronic heart failure and recent use of loop diuretics. Compared with early AKI recovery, progression to AKD was associated with increased hazard of 1-year mortality and de novo CKD (HR = 1.20, 95% CI 1.13 to 1.26 and HR = 2.21, 95% CI 1.91 to 2.57 respectively). Conclusions These findings highlight the importance of early AKI recognition and management to avoid progression to AKD and long-term adverse outcomes.

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“…For data collection, a structured questionnaire prepared by the researcher and based on scientific evidence [ 6 , 17 , 18 ] was used, consisting of 16 questions, with the following variables: gender, age, ethnicity, weight, Body Mass Index, hospitalization time in the medical clinic, comorbidities, renal replacement therapy during the medical clinic stay, and laboratory variables (serum creatinine and urea) extracted from the patient’s electronic medical chart.…”

Section: Methodsmentioning

confidence: 99%

“…In the intensive care setting, the mortality detected at one year was five times higher among patients with AKI without recovery, when compared to those with a history of rapidly reversed AKI [ 6 ] and, in non-critical care, mortality after 12 months affected 64.9% of the patients who presented with AKI [ 6 ]. A cohort study indicates that, of 534 non-critical patients with AKI, 45% presented full renal recovery and that, among them, 9% died still while hospitalized [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Recovery of Renal Function in Clinical Patients with Acute Kidney Injury: Impact on Mortality

Duarte

Magro

2022

Life

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Objective: To assess the different renal function recovery patterns and their impact on the mortality of non-critical patients with hospital-acquired Acute Kidney Injury. Design: A prospective cohort study was conducted from January 2017 to December 2019. Methods: The patients included were those with Acute Kidney Injury acquired during their hospitalization, identified from Kidney Disease: Improving Global Outcomes (KDIGO). Renal function recovery was calculated through the serum creatinine ratio in relation to baseline creatinine at the renal function evaluation moment. A descriptive analysis of the results was performed, and the Backward method was adopted for the multivariate analysis. Results: One-thousand five-hundred and forty-six patients were evaluated in the medical clinic and 202 (13.06%) were identified to have Acute Kidney Injury; among them, renal function recovery varied over the six months of follow-up with greater expressiveness in the second and third months (from 61.02% to 62.79%). Recovery was a protective factor against in-hospital death in the first (OR 0.24; 95% CI 0.09–0.61; p-value = 0.038) and sixth month of follow-up (OR 0.24; 95% CI 0.09–0.61; p-value = 0.003). Conclusions: The incidence of renal function recovery varied throughout the six months of follow-up and reached progressively high levels from the second to the third months. Renal recovery was a protective factor against mortality during the follow-up period.

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Association of persistent acute kidney injury and renal recovery with mortality in hospitalised patients

Cited by 27 publications

References 27 publications

Acute kidney injury in intensive care patients: Incidence, time course, and risk factors

Acute kidney injury in intensive care patients: Incidence, time course, and risk factors

Patient outcomes following AKI and AKD: a population-based cohort study

Recovery of Renal Function in Clinical Patients with Acute Kidney Injury: Impact on Mortality

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