Severity of Acute Kidney Injury and Two- year Outcomes in Critically Ill Patients.
Chest. 2013 May 16;
Authors: Fuchs L, Lee J, Novack V, Baumfeld Y, Scott D, Celi L, Mandelbaum T, Howell M, Talmor D
Abstract
ABSTRACT BACKGROUND: The association between levels of acute kidney injury (AKI) during ICU admission and long term mortality are not well defined. METHODS: We examined medical records of adult patients admitted to a large tertiary medical center with no history of end stage renal disease (ESRD), who survived 60 days from ICU admission between the years 2001-2007. The extracted data included demographic, clinical information, physiological data as well as dates of death. RESULTS: Among 15,048 patients, 12,399 (82.4%) survived 60 days from ICU admission and consisted the study population. 5663 (45.7%) did not develop AKI during their ICU admission, while 4589(37.0%), 1613 (13.0%) and 534 (4.3%) developed progressively severe levels of AKI as defined by the Acute Kidney Injury Network criteria (AKIN 1, AKIN 2 and AKIN 3 respectively). Only 42.5% of Patients who developed AKIN 3 survived two years from ICU admission. AKIN 3 patients had a 61% higher mortality risk two years from ICU discharge compared to patients who did not develop AKI. Patients who developed AKIN 1 and AKIN 2 had similar increased mortality risk two years from ICU admission (HR 1.26 and 1.28 respectively). Level of estimated glomerular filtration rate (eGFR) on ICU discharge and chronic kidney disease (CKD) were found to be associated with long term mortality. CONCLUSIONS: Patients who develop AKI in the ICU have significantly increased risks of death that extend beyond their high ICU mortality rates. These increased risks of death continue for at least two years after the index ICU admission.
PMID: 23681257 [PubMed - as supplied by publisher]