Long-term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: a 10-year prospective cohort study

Helmut Schiffl, Susanne M Lang, Rainald Fischer, Helmut Schiffl, Susanne M Lang, Rainald Fischer

Abstract

Background: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high in-hospital morbidity and mortality in critically ill patients. Long-term outcomes have received little attention.

Methods: The aim of this study was to characterize AKI-chronic kidney disease (CKD) nexus in critically ill patients with AKI (RIFLE class F). We performed a single-centre prospective observational study of 425 consecutive critically ill patients with AKI requiring RRT. None of these patients had pre-existing kidney disease. Primary outcomes were vital status and renal function at hospital discharge and at 5 and 10 years of follow-up.

Results: The overall in-hospital mortality of the study cohort was 47%, the mortality rates at 1, 5 and 10 years were 65, 75 and 80%, respectively. At hospital discharge, recovery of renal function was complete in 56% of survivors. None of these patients developed CKD during follow-up. Ninety percent of the 100 survivors with partial recovery of renal function had ongoing CKD during long-term follow-up. CKD progressed to end-stage renal disease (ESRD) in 12 patients (3% of the cohort or 5% of survivors). The patients with post-AKICKD had a higher prevalence of hypertension, a higher rate of fatal cardiac diseases and a higher all-cause death rate.

Conclusion: Long-term survival of critically ill patients with AKI requiring RRT is poor and determined by the development of de novo CKD. There is a need for close follow-up of patients surviving AKI to prevent progressive CKD and to reduce associated lethal cardiac events.

Keywords: acute kidney injury; long-term mortality; risk of chronic kidney disease; survival.

Figures

Fig. 1.
Fig. 1.
Outcome of the study cohort. ICU, intensive care unit; CRR, complete renal recovery; PRR, partial renal recovery; NRF, normal renal recovery; CKD, chronic kidney disease.
Fig. 2.
Fig. 2.
Survival curve of the cohort of critically ill patients with AKI requiring RRT.
Fig. 3.
Fig. 3.
Number of survivors from AKI (RIFLE class F) developing end-stage renal disease during a 10-year follow-up period. ESRD, end-stage renal disease.

References

    1. Ostermann M, Chang RW. Challenges of defining acute kidney injury. QJM. 2011;104:237–243.
    1. Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10:R73.
    1. Bagshaw SM, George C, Bellomo R. Changes in the incidence and outcome for early acute kidney injury in a cohort of Australian intensive care units. Crit Care. 2007;11:R68.
    1. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–818.
    1. Cruz DN, Bolgan I, Perazella MA, et al. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol. 2007;2:418–425.
    1. Star RA. Treatment of acute renal failure. Kidney Int. 1998;54:1817–1831.
    1. Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010;38:261–275.
    1. Liano F, Felipe C, Tenorio MT, et al. Long-term outcome of acute tubular necrosis: a contribution to its natural history. Kidney Int. 2007;71:679–686.
    1. Bagshaw SM, Laupland KB, Doig CJ, et al. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care. 2005;9:R700–R709.
    1. Schmitt R, Coca S, Kanbay M, et al. Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis. 2008;52:262–271.
    1. Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20:223–228.
    1. Lo LJ, Go AS, Chertow GM, et al. Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease. Kidney Int. 2009;76:893–899.
    1. Bucaloiu ID, Kirchner HL, Norfolk ER, et al. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012;81:477–485.
    1. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81:442–448.
    1. Palevsky PM. Chronic-on-acute kidney injury. Kidney Int. 2012;81:430–431.
    1. Schiffl H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. Nephrol Dial Transplant. 2006;21:1248–1252.
    1. Schiffl H, Fischer R. Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant. 2008;23:2235–2241.
    1. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–S266.
    1. Morgera S, Kraft AK, Siebert G, et al. Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis. 2002;40:275–279.
    1. Ahlstrom A, Tallgren M, Peltonen S, et al. Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med. 2005;31:1222–1228.
    1. Frost L, Pedersen RS, Bentzen S, et al. Short and long term outcome in a consecutive series of 419 patients with acute dialysis-requiring renal failure. Scand J Urol Nephrol. 1993;27:453–462.
    1. Hobson CE, Yavas S, Segal MS, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation. 2009;119:2444–2453.
    1. Fertmann J, Wolf H, Kuchenhoff H, et al. Prognostic factors in critically ill surgical patients requiring continuous renal replacement therapy. J Nephrol. 2008;21:909–918.
    1. Rimes-Stigare C, Awad A, Martensson J, et al. Long-term outcome after acute renal replacement therapy: a narrative review. Acta Anaesthesiol Scand. 2011;56:138–146.
    1. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105:2259–2264.
    1. Ng KP, Chanouzas D, Fallouh B, et al. Short and long-term outcome of patients with severe acute kidney injury requiring renal replacement therapy. QJM. 2012;105:33–39.
    1. Bhandari S, Turney JH. Survivors of acute renal failure who do not recover renal function. QJM. 1996;89:415–421.
    1. Wu VC, Huang TM, Lai CF, et al. Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Ki.dney Int. 2011;80:1222–1230.
    1. Ponte B, Felipe C, Muriel A, et al. Long-term functional evolution after an acute kidney injury: a 10-year study. Nephrol Dial Transplant. 2008;23:3859–3866.
    1. Spurgeon-Pechman KR, Donohoe DL, Mattson DL, et al. Recovery from acute renal failure predisposes hypertension and secondary renal disease in response to elevated sodium. Am J Physiol Renal Physiol. 2007;293:F269–F278.
    1. Venkatachalam MA, Griffin KA, Lan R, et al. Acute kidney injury: a springboard for progression in chronic kidney disease. Am J Physiol Renal Physiol. 2010;298:F1078–F1094.
    1. Faulhaber-Walter R, Hafer C, Jahr N, et al. The Hannover Dialysis Outcome study: comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. Nephrol Dial Transplant. 2009;24:2179–2186.
    1. Siew ED, Peterson JF, Eden SK, et al. Outpatient Nephrology Referral Rates after Acute Kidney Injury. J Am Soc Nephrol. 2012;23:305–312.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren