Population-based incidence, mortality and quality of life in critically ill patients treated with renal replacement therapy: a nationwide retrospective cohort study in finnish intensive care units

Abstract

IntroductionAcute kidney injury (AKI) increases mortality and morbidity of critically ill patients. Mortality of patients treated with renal replacement therapy (RRT) is high. We aimed to evaluate the nationwide incidence of RRT-treated AKI in Finland, hospital and six-month mortality, and health-related quality of life (HRQoL) of these patients.MethodsWe performed a retrospective cohort study including all general intensive care unit (ICU) admissions in Finland in 2007 through 2008. We identified patients who had received RRT due to AKI (RRT patients) and compared these patients to ICU patients who were not treated with RRT (non-RRT patients). The HRQoL was assessed by the EQ-5D index and visual analogue scale (VAS).ResultsWe analysed the final cohort of 24,904 patients, of whom 1,686 received RRT due to AKI. The incidence of RRT-treated AKI was 6.8% (95% confidence interval (CI) 6.5 to 7.1%) among ≥ 15-year-old general ICU patients, which corresponds to a yearly population-based incidence of 19.2 per 100,000 (95% CI 17.9 to 20.5/100,000). According to RIFLE (Risk, Injury, Failure) classification 26.6% (95% CI 26.0 to 27.2%) of patients had AKI (RIFLE R-F). Hospital and six-month mortality of RRT patients were 35.0% and 49.4%. At six-months, RRT patients perceived their health as good as non-RRT patients by VAS.ConclusionsThe population-based incidence of AKI treated with RRT was 19.2 per 100,000 in Finland and 6.8% of all general ICU patients. The hospital and six-month mortality rates were lower than previously reported for ICU-treated RRT patients.

Psychological outcomes in critically ill patients receiving renal replacement therapy: a matched‐pairs analysis

“…Our findings are supported by the small number of other studies that have compared QoL outcomes in ICU patients with and without AKI [2,9,11]. None of these studies looked specifically at psychological morbidity, and only one [11] included a matched-pairs analysis.…”

“…It is associated with a poor prognosis, with a hospital mortality of between 35% and 63.8% [2,3]. Among survivors, there is a continued adverse impact on quality of life (QoL) [4].…”

“…Among survivors, there is a continued adverse impact on quality of life (QoL) [4]. Studies that have assessed the impact of AKI with or without RRT on QoL have used global measures that incorporate physical, pain, social and other parameters, as well as psychological morbidity [2,[5][6][7][8][9][10][11][12]. There is a paucity of data on the specific psychological impact of RRT.…”

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

“…When considering pathophysiology, this phase is always preceded by kidney attacks (of mostly haemodynamic or inflammatory nature), which can lead to irreversible parenchymal kidney damage and finally renal dysfunction when repeated [14,15]. Currently, no curative strategies enable clinicians to treat such established damage, and AKI is clearly associated with an increased independent risk of in-hospital mortality and CRI within a few years following AKI [16][17][18][19][20][21]. Therefore, current data strongly suggest the need to research risk factors for AKI and to detect early kidney attack episodes [1,[22][23][24].…”

“…In the ICU, fluid overload is associated with an increased incidence in AKI and its severity, regardless of the need for RRT [21,[104][105][106][107][108]. An increase in weight above 10 % is the most frequently studied parameter.…”