Burden of acute kidney injury and 90-day mortality in critically ill patients

Abstract

BackgroundMortality rates associated with acute kidney injury (AKI) vary among critically ill patients. Outcomes are often not corrected for severity or duration of AKI. Our objective was to analyse whether a new variable, AKI burden, would outperform 1) presence of AKI, 2) highest AKI stage, or 3) AKI duration in predicting 90-day mortality.MethodsKidney Diseases: Improving Global Outcomes (KDIGO) criteria using creatinine, urine output and renal replacement therapy were used to diagnose AKI. AKI burden was defined as AKI stage multiplied with the number of days that each stage was present (maximum five), divided by the maximum possible score yielding a proportion. The AKI burden as a predictor of 90-day mortality was assessed in two independent cohorts (Finnish Acute Kidney Injury, FINNAKI and Simple Intensive Care Studies I, SICS-I) by comparing four multivariate logistic regression models that respectively incorporated either the presence of AKI, the highest AKI stage, the duration of AKI, or the AKI burden.ResultsIn the FINNAKI cohort 1096 of 2809 patients (39%) had AKI and 90-day mortality of the cohort was 23%. Median AKI burden was 0.17 (IQR 0.07–0.50), 1.0 being the maximum. The model including AKI burden (area under the receiver operator curve (AUROC) 0.78, 0.76–0.80) outperformed the models using AKI presence (AUROC 0.77, 0.75–0.79, p = 0.026) or AKI severity (AUROC 0.77, 0.75–0.79, p = 0.012), but not AKI duration (AUROC 0.77, 0.75–0.79, p = 0.06). In the SICS-I, 603 of 1075 patients (56%) had AKI and 90-day mortality was 28%. Median AKI burden was 0.19 (IQR 0.08–0.46). The model using AKI burden performed better (AUROC 0.77, 0.74–0.80) than the models using AKI presence (AUROC 0.75, 0.71–0.78, p = 0.001), AKI severity (AUROC 0.76, 0.72–0.79. p = 0.008) or AKI duration (AUROC 0.76, 0.73–0.79, p = 0.009).ConclusionAKI burden, which appreciates both severity and duration of AKI, was superior to using only presence or the highest stage of AKI in predicting 90-day mortality. Using AKI burden or other more granular methods may be helpful in future epidemiological studies of AKI.

Clinically Distinct Subtypes of Acute Kidney Injury on Hospital Admission Identified by Machine Learning Consensus Clustering

“…Patients in this cluster also suffered from more severe AKI than other clusters. AKI and the associated electrolyte imbalances and acidbase disorders may have contributed to the observed increased mortality risk [29][30][31][32]. In addition, they were more likely to have comorbidities, including diabetes mellitus and cirrhosis, which have been shown in prior studies to portend a worse prognosis.…”

“…Although clusters #2 and #3 were older and had higher comorbidities than those in cluster #4, patients in clusters #4 carried higher in-hospital and one-year mortality risks. This is likely due to the significant impacts of AKI severity, infectious disease, and hyponatremia on poor outcomes [32,33]. The findings of our study suggest that the use of the ML approach may help identify potential new pathophysiological pathways leading to CA-AKI.…”

Acute kidney injury adversely affects the clinical course of acute myeloid leukemia patients undergoing induction chemotherapy

“…In this study, we confirmed the association of AKI and ICU treatment in AML patients as already described by others [ 8 , 19 ]. Sepsis-associated inflammatory response with a potential disruption of renal perfusion as a consequence is known to be a common risk factor for AKI ( https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf ) [ 6 , 20 ].…”

“…However, TRM remains at a level of 8-15% during induction chemotherapy [3,4]. AKI is one of the most important organ failures associated with increased mortality and need for ICU treatment in hospitalized patients [6,17]. To the best of our knowledge, the last investigation on the role of AKI in adult patients with AML undergoing intensive induction therapy was published in 2010, while the most recent investigation focused on pediatric AML populations [7,8].…”

“…Acute kidney injury (AKI) is defined by a rapid and partly reversible restriction of kidney function causing a reduction of renal glomerular filtration rate (GFR) [ 5 ]. AKI has been shown to be associated with increased mortality and a higher rate of treatment on intensive care units (ICU) in hospitalized patients [ 5 , 6 ]. In pediatric AML patients undergoing intensive chemotherapy, AKI has been correlated to volume depletion, sepsis, and nephrotoxic medications, and a higher risk for developing chronic kidney disease later [ 7 ].…”