Six-month survival and quality of life of intensive care patients with acute kidney injury

Abstract

IntroductionAcute kidney injury (AKI) has high incidence among the critically ill and associates with dismal outcome. Not only the long-term survival, but also the quality of life (QOL) of patients with AKI is relevant due to substantial burden of care regarding these patients. We aimed to study the long-term outcome and QOL of patients with AKI treated in intensive care units.MethodsWe conducted a predefined six-month follow-up of adult intensive care unit (ICU) patients from the prospective, observational, multi-centre FINNAKI study. We evaluated the QOL of survivors with the EuroQol (EQ-5D) questionnaire. We included all participating sites with at least 70% rate of QOL measurements in the analysis.ResultsOf the 1,568 study patients, 635 (40.5%, 95% confidence interval (CI) 38.0-43.0%) had AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of the 635 AKI patients, 224 (35.3%), as compared to 154/933 (16.5%) patients without AKI, died within six months. Of the 1,190 survivors, 959 (80.6%) answered the EQ-5D questionnaire at six months. The QOL (median with Interquartile range, IQR) measured with the EQ-5D index and compared to age- and sex-matched general population was: 0.676 (0.520-1.00) versus 0.826 (0.812-0.859) for AKI patients, and 0.690 (0.533-1.00) versus 0.845 (0.812-0.882) for patients without AKI (P <0.001 in both). The EQ-5D at the time of ICU admission was available for 774 (80.7%) of the six-month respondents. We detected a mean increase of 0.017 for non-AKI and of 0.024 for AKI patients in the EQ-5D index (P = 0.728). The EQ-5D visual analogue scores (median with IQR) of patients with AKI (70 (50–83)) and patients without AKI (75 (60–87)) were not different from the age- and sex-matched general population (69 (68–73) and 70 (68–77)).ConclusionsThe health-related quality of life of patients with and without AKI was already lower on ICU admission than that of the age- and sex-matched general population, and did not change significantly during critical illness. Patients with and without AKI rate their subjective health to be as good as age and sex-matched general population despite statistically significantly lower QOL indexes measured by EQ-5D.

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.…”

“…Among patients receiving haemodialysis for end-stage renal disease, symptoms of anxiety and depression are common, with 45.7% of subjects meeting criteria for an anxiety disorder [16] and 23.7% with significant depressive symptoms [17]. Symptoms consistent with post-traumatic stress are also common in this patient [11] assessed QoL in survivors of critical illness with AKI across ten centres in Finland, using the EuroQol-5D (EQ-5D) questionnaire. Subjects were assessed at six months.…”

“…None of these studies looked specifically at psychological morbidity, and only one [11] included a matched-pairs analysis.…”

“…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.…”

Low Systemic Oxygen Delivery and BP and Risk of Progression of Early AKI

“…Survivors of AKI are at risk of CKD, even if renal function initially recovers (4)(5)(6)(7)(8)(9)(10). In the United Kingdom, the annual cost of AKI to the National Health Service (NHS) is estimated at ₤1.02 billion, which is more than the expenditure on common cancers combined (11).…”