Importance of duration of acute kidney injury after severe trauma: a cohort study

Abstract

BackgroundAcute kidney injury (AKI) is common after severe trauma. AKI incidence and AKI stage have previously been shown to be associated with poor outcomes after trauma. However, AKI duration may also be important for outcomes after trauma, given that it is associated with long-term morbidity and mortality in general intensive care unit (ICU) and hospitalized patients. We hypothesized that duration of AKI is independently associated with poor outcomes after trauma.MethodsA cohort study was conducted at a single, level 1 trauma center. Patients admitted to the ICU between 2009 and 2018 were included. Data were extracted from the trauma registry and electronic medical records. AKI within 7 days from presentation was defined according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable analyses were performed to assess the association between AKI incidence, AKI stage, and AKI duration with outcomes including prolonged ICU and hospital length of stay, discharge to home, and mortality.ResultsOf 7049 patients included, 72% were male, the median age was 41 years (IQR 27–58), and 10% died. The AKI incidence was 45%, with 69% of these patients presenting with AKI on arrival. The majority (73%) of patients who suffered AKI recovered within 2 days. After adjustment in separate models, AKI incidence, AKI stage and AKI duration were each associated with prolonged hospitalization, an unfavorable discharge disposition, and mortality. AKI stage and duration were not used in the same model due to collinearity.ConclusionsPost-traumatic AKI was common on arrival and frequently short lasting. Duration correlated with highest AKI stage, and both were separately associated with prolonged hospitalization, discharge destination other than home, and mortality on adjusted analyses. Given the high incidence of AKI on arrival, stage or duration may be better targets for future interventions and quality improvement initiatives to improve outcomes after post-traumatic AKI.Level of evidenceIII. Prognostic.

Incidence and Burden of Acute Kidney Injury among Traumatic Brain-Injury Patients

“…Most of previous studies have confirmed the association between prolonged AKI duration and poorer prognosis in various kinds of patients, including diabetics, those undergoing cardiac surgery, and the critically ill patients. 20 , 24–27 However, another two studies verified that AKI duration was not associated with mortality in critically ill patients. 28 , 29 We considered that the correlation between AKI duration and outcome may be confounded by illness severity, demographic characteristics, underlying diseases, and AKI stage.…”

Failing kidneys: renal replacement therapies in the ICU

“…69% of the AKI group (31% of all patients) had signs of renal dysfunction at admission, but the majority experienced renal recovery within 2 days. 3 The incidence of AKI after surgery ranges from 5% after major abdominal surgeries to nearly 50% after orthotopic liver transplantation. 2 Common causes of AKI in the post-trauma and postsurgical groups include acute tubular necrosis resulting from renal ischemia secondary to hypovolemia, hemorrhage, or shock state, systemic inflammatory response, and nephrotoxic agents including many medications especially antibiotics and non-steroidal anti-inflammatory drugs and myoglobin from rhabdomyolysis.…”