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Small Acute Increases in Serum Creatinine are Associated with Decreased Long Term Survival in the Critically Ill.
Am J Respir Crit Care Med. 2014 Mar 6;
Authors: Linder A, Fjell C, Levin A, Walley KR, Russell JA, Boyd JH
Abstract
Rationale: Long-term outcome after acute kidney injury (AKI) are poorly described. Objective: We hypothesized that one single episode of minimal (stage I) AKI is associated with reduced long-term survival compared to no acute kidney injury (No AKI) following recovery from critical illness. Methods: A prospective cohort of intensive care unit patients (ICU) of 2010 patients admitted to the ICU between year 2000 and 2009 at a provincial tertiary care hospital. Development of AKI was determined according to the KDIGO classification and mortality up to 10 years after ICU admission was recorded. Main results: Of the 1844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had No AKI. The 28-day, 1-year, 5-year and 10-year survival rates were 67.1%, 51.8%, 44.1%, and 36.3%, in patients with mild AKI, which was significantly worse compared to the critically ill patients with no AKI at any time (P<0.01). The unadjusted 10-year mortality hazard ratio was 1.53 (95% CI 1.2-2.0) for 28-day survivors with stage 1 AKI compared to critically ill patients with no AKI. Adjusted 10-year mortality risk was 1.26 (1.0 to 1.6). After propensity matching stage 1 AKI with no AKI patients, mild AKI was still significantly associated with decreased 10-year survival (P=0.036). Conclusions: Patients with one episode of mild AKI have significantly lower long-term survival rates than critically ill patients with No AKI. Close medical follow-up of these patients may be warranted and mechanistic research is required to understand how AKI influences long-term events.
PMID: 24601781 [PubMed - as supplied by publisher]