ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients

A S Truche, S Perinel Ragey, B Souweine, S Bailly, L Zafrani, L Bouadma, C Clec'h, M Garrouste-Orgeas, G Lacave, C Schwebel, F Guebre-Egziabher, C Adrie, A S Dumenil, Ph Zaoui, L Argaud, S Jamali, D Goldran Toledano, G Marcotte, J F Timsit, M Darmon, A S Truche, S Perinel Ragey, B Souweine, S Bailly, L Zafrani, L Bouadma, C Clec'h, M Garrouste-Orgeas, G Lacave, C Schwebel, F Guebre-Egziabher, C Adrie, A S Dumenil, Ph Zaoui, L Argaud, S Jamali, D Goldran Toledano, G Marcotte, J F Timsit, M Darmon

Abstract

Background: Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality.

Design: Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day.

Setting: 23 French ICUs.

Patients: Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015.

Intervention: None.

Results: A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46-0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI.

Conclusions: Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients.

Keywords: Acute kidney injury; Epidemiology and outcome; Intensive care unit; Renal recovery; Renal replacement therapy.

Figures

Fig. 1
Fig. 1
Flowchart. AKI acute kidney injury; KDIGO kidney disease: improving global outcomes; ICU intensive care unit
Fig. 2
Fig. 2
Survival curve according to persistence of acute kidney injury defined as an absence of renal recovery occurring within the first 3 days. n = 3584, Log rank < 0.01. AKI acute kidney injury
Fig. 3
Fig. 3
Renal replacement therapy requirement according to persistent and transient acute kidney injury defined at various time frames: n = 2055. AKI acute kidney injury

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