Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

Abstract

Background: Critically ill patients with acute kidney injury (AKI) in need of renal replacement therapy (RRT) may have a protracted and often incomplete rehabilitation. Their long-term outcome has rarely been investigated. Study design: Survivors of the HANnover Dialysis OUTcome (HANDOUT) study were evaluated after 5 years for survival, health status, renal function, and quality of life (QoL). The HANDOUT study had examinded mortality and renal recovery of patients with AKI receiving either standard extendend or intensified dialysis after multi organ failure. Results: One hundred fifty-six former HANDOUT participants were analyzed. In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% (86.5% if discharged from hospital). Main causes of death were cardiovascular complications and sepsis. A total of 19 survivors presented to the outpatient department of our clinic and had good renal recovery (mean estimated glomerular filtration rate 72. Quality-adjusted life-years after 5 years were 3.365. Conclusion: Mortality after severe AKI is higher than short-term prospective studies show, and morbidity is significant. Kidney recovery as well as general health remains incomplete. Reduction of QoL is minor, and social rehabilitation is very good. Affectivity is heterogeneous, but most patients experience emotional well-being. In summary, AKI in critically ill patients leads to incomplete rehabilitation but acceptable QoL after 5 years.

Long-term quality of life postacute kidney injury in cardiac surgery patients

“…In the HANDOUT study published in 2016, the authors investigated the QOL post-RRT in general ICU patients. [ 16 ] They reported that their assessment of QOL using the SF-36 did not reveal significant physical limitations in their patient group. This could either be due to the fact that they were able to investigate only a small number of patients (21 patients) as compared to 499 patients in this study and/or they did not have another group for comparison of the QOL.…”

Quality of life following hospitalization-associated acute kidney injury in children

“…Adult studies have focused on critically ill patients receiving renal replacement therapy. Results have been varied, with some studies demonstrating a reduction in HRQOL [7,11] while others do not demonstrate a difference in HRQOL following AKI [10,[22][23][24]. Nisula et al did evaluate critically ill adults with varying AKI stages, not just those requiring RRT, and did not find differences in quality of life scores among that cohort [24].…”

Cost-effectiveness analysis of Vaborem in Carbapenem-resistant Enterobacterales (CRE) -Klebsiella pneumoniae infections in Italy

“…Since QoL data were not collected during the TANGO II study [ 15 ], health utilities were retrieved from literature [ 23 – 27 ]. The health utilities considered in the analysis were associated to the following health states: (i) hospitalisation without nephrotoxicity [ 27 ], (ii) hospitalisation with nephrotoxicity [ 25 ], (iii) acute RRT [ 25 ], (iv) chronic RRT [ 26 ], (v) discharged home [ 23 ] and (vi) discharged to long-term care (LTC) [ 28 ]. The same utility values were considered in a previously published economic evaluation of CRE population [ 24 ].…”