Long-term outcomes after severe acute kidney injury in critically ill patients: the SALTO study

Abstract

Background The extent of the consequences of an episode of severe acute kidney injury (AKI) on long-term outcome of critically ill patients remain debated. We conducted a prospective follow-up of patients included in a large multicenter clinical trial of renal replacement therapy (RRT) initiation strategy during severe AKI (the Artificial Kidney Initiation in Kidney Injury, AKIKI) to investigate long-term survival, renal outcome and health related quality of life (HRQOL). We also assessed the influence of RRT initiation strategy on these outcomes. Results Follow-up of patients extended from 60 days to a median of 3.35 years [interquartile range (IQR), 1.89 to 4.09] after the end of initial study. Of the 619 patients included in the AKIKI trial, 316 survived after 60 days. The overall survival rate at 3 years from inclusion was 39.4% (95% CI 35.4 to 43.4). A total of 46 patients (on the 175 with available data on long-term kidney function) experienced worsening of renal function (WRF) at the time of follow-up [overall incidence of 26%, cumulative incidence at 4 years: 20.6% (CI 95% 13.0 to 28.3)]. Fifteen patients required chronic dialysis (5% of patients who survived after day 90). Among the 226 long-term survivors, 80 (35%) answered the EQ-5D questionnaire. The median index value reported was 0.67 (IQR 0.40 to 1.00) indicating a noticeable alteration of quality of life. Initiation strategy for RRT had no effect on any long-term outcome. Conclusion Severe AKI in critically ill patients was associated with a high proportion of death within the first 2 months but less so during long-term follow-up. A quarter of long-term survivors experienced a WRF and suffered from a noticeable impairment of quality of life. Renal replacement therapy initiation strategy was not associated with mortality outcome. Graphical Abstract

Clinical Profile and Short-Term Outcomes of Acute Kidney Injury in Elderly Patients in a Tertiary Care Center

“…However, long-term follow-up showed a lower mortality rate. Among the long-term survivors, a quarter experienced worsening renal function and a significant decline in quality of life [17].…”

Acute Kidney Injury Following Caesarean Section: A Case Report

“…In cases of emergency, dialysis or kidney replacement therapy may be necessary to manage severe symptoms, such as pulmonary oedema, hyperkalaemia, or uremic symptoms [8,10]. Patients with moderate to severe AKI should have an outpatient nephrology review to monitor renal function and blood pressure to prevent the development of chronic kidney disease [11].…”

Quality of life after acute kidney injury

“…The AKIKI study was a large French multicentre RCT on RRT initiation strategy for AKI. Chaibi et al [73 ▪▪ ] examined HRQOL in 316 patients [72] (51% of total population) who survived 60 days after randomization. Their median follow-up was up to 3.35 years [interquartile range (IQR) 1.89–4.09].…”