Long-term survival in patients with septic acute kidney injury is strongly influenced by renal recovery

Abstract

Background: Several studies have shown that long-term survival after acute kidney injury (AKI) is reduced even if there is clinical recovery. However, we recently reported that in septic shock patients those that recover from AKI have survival similar to patients without AKI. Here, we studied a cohort with less severe sepsis to examine the effects of AKI on longer-term survival as a function of recovery by discharge.

Methods: We analyzed patients with community-acquired pneumonia from the Genetic and Inflammatory Markers of Sepsis (GenIMS) cohort. We included patients who developed AKI (KDIGO stages 2-3) and defined renal recovery as alive at hospital discharge with return of SCr to within 150% of baseline without dialysis. Our primary outcome was survival up to 3 years analyzed using Gray's model.

Results: Of the 1742 patients who survived to hospital discharge, stage 2-3 AKI occurred in 262 (15%), of which 111 (42.4%) recovered. Compared to recovered patients, patients without recovery were older (75 ±14 vs 69 ±15 years, p<0.001) and were more likely to have at least stage 1 AKI on day 1 (83% vs 52%, p<0.001). Overall, 445 patients (25.5%) died during follow-up, 23.4% (347/1480) for no AKI, 28% (31/111) for AKI with recovery and 44.3% (67/151) for AKI without recovery. Patients who did not recover had worse survival compared to no AKI (HR range 1.05-2.46, p = 0.01), while recovering patients had similar survival compared to no AKI (HR 1.01, 95%CI 0.69-1.47, p = 0.96). Absence of AKI on day 1, no in-hospital renal replacement therapy (RRT), higher Apache III score and higher baseline SCr were associated with recovery after AKI.

Conclusions: In patients with sepsis, recovery by hospital discharge is associated with long-term survival similar to patients without AKI.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of study population.

Fig 2. Kaplan-Meier survival curves stratified by recovery status.

The three groups are significantly different overall, p

Fig 3. Time-varying covariate effects with 95% confidence intervals of renal recovery at hospital discharge in Gray’s model.

Hazard ratios (HR) of Non-recovery vs No AKI from the Gray’s model are reported as the minimum to maximum covariate effect during 10 time intervals. AKI: Acute kidney injury; PSI: Pneumonia Severity Index (on day 1, without age).