Short and long-term outcome of patients with severe acute kidney injury requiring renal replacement therapy

Ng, Khai Ping; Chanouzas, Dimitrios; Fallouh, Bassam; Baharani, Jyoti

doi:10.1093/qjmed/hcr133

Cited by 31 publications

(25 citation statements)

References 25 publications

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“…One-year mortality in our study was 38.8%, along the lines of previous findings [45,46,47]. Interestingly, the presence of DM or HTN did not influence 1-year mortality.…”

Section: Discussionsupporting

confidence: 91%

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

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Background: Epidemiological studies of acute kidney injury (AKI) have focused on patients admitted to intensive care units (ICUs), and several have studied hospitalized non-ICU patients, but analysis of patients referred to Nephrology is sparse. We analyzed factors associated with short- and long-term morbimortality among hospitalized non-ICU patients with AKI who were referred to Nephrology. Methods: A retrospective study with data prospectively collected from 170 non-ICU patients, with referral to the Nephrology Unit, recruited over a 4-year period, was performed. AKI was classified according to the criteria based on risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE). Risk factors that could influence prognosis of AKI and long-term mortality were analyzed at admission. Early on, 1- and 10-year mortalities were correlated with AKI RIFLE class, clinical and demographic characteristics. Results: Most patients were >65 years, with multiple comorbidities and frequent drug intake history. Median Charlson score was 6. Twenty-five percent of patients with previously unknown chronic kidney disease (CKD) were diagnosed with CKD during the study. Dialysis was required in 13.5% of patients. Hospital deaths were 22.4% and significantly associated with older age, RIFLE class L, higher peak serum creatinine, oliguria and decreased serum albumin levels. One-year (38.8%) and 10-year (68.8%) mortalities were significantly associated with age, prior cardiovascular disease, prior CKD and RIFLE class L. According to the Cox proportional hazard model, age, prior CKD and RIFLE class L were independent risk factors of death at 1 and 10 years. Conclusions: AKI in hospitalized non-ICU patients is associated with high early and late mortality. This study increases our understanding of AKI among this specific population and can improve their management.

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“…One-year mortality in our study was 38.8%, along the lines of previous findings [45,46,47]. Interestingly, the presence of DM or HTN did not influence 1-year mortality.…”

Section: Discussionsupporting

confidence: 91%

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

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“…The HANDOUT 1-yearsurvival of 44.6% compares well to 37% reported by Ng et al, 24 in a study including patients with preexisting CKD. In contrast, Carl et al 25 reported only 24.6% 1-year survival in a septic study population with AKI.…”

Section: Discussion Survivalsupporting

confidence: 82%

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

Faulhaber-Walter

Scholz²,

Haller

et al. 2016

IJNRD

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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.

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“…Among the critically ill patients admitted to the intensive care unit (ICU), approximately 4–15% develop AKI that requires renal replacement therapy (RRT), and AKI is associated with a significant in-hospital mortality rate of 50–80% [4], [5]. To date, RRT remains a critical supportive measure for AKI [6].…”

Section: Introductionmentioning

confidence: 99%

U-Curve Association between Timing of Renal Replacement Therapy Initiation and In-Hospital Mortality in Postoperative Acute Kidney Injury

Shiao

et al. 2012

PLoS ONE

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BackgroundPostoperative acute kidney injury (AKI) is associated with poor outcomes in surgical patients. This study aims to evaluate whether the timing of renal replacement therapy (RRT) initiation affects the in-hospital mortality of patients with postoperative AKI.MethodologyThis multicenter retrospective observational study, which was conducted in the intensive care units (ICUs) in a tertiary hospital (National Taiwan University Hospital) and its branch hospitals in Taiwan between January, 2002, and April, 2009, included adult patients with postoperative AKI who underwent RRT for predefined indications. The demographic data, comorbid diseases, types of surgery and RRT, and the indications for RRT were documented. Patients were categorized according to the period of time between the ICU admission and RRT initiation as the early (EG, ≦1 day), intermediate (IG, 2–3 days), and late (LG, ≧4 days) groups. The in-hospital mortality rate censored at 180 day was defined as the endpoint.ResultsSix hundred forty-eight patients (418 men, mean age 63.0±15.9 years) were enrolled, and 379 patients (58.5%) died during the hospitalization. Both the estimated probability of death and the in-hospital mortality rates of the three groups represented U-curves. According to the Cox proportional hazard method, LG (hazard ratio, 1.527; 95% confidence interval, 1.152–2.024; P = 0.003, compared with IG group), age (1.014; 1.006–1.021), diabetes (1.279; 1.022–1.601; P = 0.031), cirrhosis (2.147; 1.421–3.242), extracorporeal membrane oxygenation support (1.811; 1.391–2.359), initial neurological dysfunction (1.448; 1.107–1.894; P = 0.007), pre-RRT mean arterial pressure (0.988; 0.981–0.995), inotropic equivalent (1.006; 1.001–1.012; P = 0.013), APACHE II scores (1.055; 1.037–1.073), and sepsis (1.939; 1.536–2.449) were independent predictors of the in-hospital mortality (All P<0.001 except otherwise stated).ConclusionsThe current study found a U-curve association between the timing of the RRT initiation after the ICU admission and patients’ in-hospital mortalities, and alerts physicians of certain factors affecting the outcome after the RRT initiation.

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Short and long-term outcome of patients with severe acute kidney injury requiring renal replacement therapy

Abstract: The short- and long-term survival outcome of severe AKI requiring RRT remains poor. Among those who survive, a significant number either continue to require RRT or have residual renal impairment necessitating ongoing follow-up.

Cited by 31 publications

References 25 publications

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

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

U-Curve Association between Timing of Renal Replacement Therapy Initiation and In-Hospital Mortality in Postoperative Acute Kidney Injury

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