Five-year risk of end-stage renal disease among intensive care patients surviving dialysis-requiring acute kidney injury: a nationwide cohort study

Henrik Gammelager, Christian Fynbo Christiansen, Martin Berg Johansen, Else Tønnesen, Bente Jespersen, Henrik Toft Sørensen, Henrik Gammelager, Christian Fynbo Christiansen, Martin Berg Johansen, Else Tønnesen, Bente Jespersen, Henrik Toft Sørensen

Abstract

Introduction: Dialysis-requiring acute kidney injury (D-AKI) is common among intensive care unit (ICU) patients. However, follow-up data on the risk of end-stage renal disease (ESRD) among these patients remain sparse. We assessed the short-term and long-term risk of ESRD after D-AKI, compared it with the risk in other ICU patients, and examined the risk within subgroups of ICU patients.

Methods: We used population-based medical registries to identify all adult patients admitted to an ICU in Denmark from 2005 through 2010, who survived for 90 days after ICU admission. D-AKI was defined as needing acute dialysis at or after ICU admission. Subsequent ESRD was defined as a need for chronic dialysis for more than 90 days or a kidney transplant. We computed the cumulative ESRD risk for patients with D-AKI and for other ICU patients, taking into account death as a competing risk, and computed hazard ratios (HRs) using a Cox model adjusted for potential confounders.

Results: We identified 107,937 patients who survived for 90 days after ICU admission. Of these, 3,062 (2.8%) had an episode of D-AKI following ICU admission. The subsequent risk of ESRD up to 180 days after ICU admission was 8.5% for patients with D-AKI, compared with 0.1% for other ICU patients. This corresponds to an adjusted HR of 105.6 (95% confidence interval (CI): 78.1 to 142.9). Among patients who survived 180 days after ICU admission without developing ESRD (n = 103,996), the 181-day to 5-year ESRD risk was 3.8% for patients with D-AKI, compared with 0.3% for other ICU patients, corresponding to an adjusted HR of 6.2 (95% CI: 4.7 to 8.1). During the latter period, the impact of AKI was most pronounced in the youngest patients, aged 15 to 49 years (adjusted HR = 12.8, 95% CI: 6.5 to 25.4) and among patients without preexisting chronic kidney disease (adjusted HR = 11.9, 95% CI: 8.5 to 16.8).

Conclusion: D-AKI is an important risk factor for ESRD for up to five years after ICU admission.

Figures

Figure 1
Figure 1
Cumulative five-year risk curve of ESRD by D-AKI status, Denmark, 2005 to 2010. AKI, acute kidney injury; ESRD, end-stage renal disease; ICU, intensive care unit

References

    1. Kellum JA, Bellomo R, Ronco C. Kidney attack. JAMA. 2012;17:2265–2266. doi: 10.1001/jama.2012.4315.
    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C. Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;17:813–818. doi: 10.1001/jama.294.7.813.
    1. Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M, Godinez-Luna T, Svenson LW, Rosenal T. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care. 2005;17:R700–R709. doi: 10.1186/cc3879.
    1. Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007;17:1837–1843. doi: 10.1097/01.CCM.0000277041.13090.0A.
    1. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;17:2051–2058. doi: 10.1097/00003246-200209000-00016.
    1. Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;17:961–973. doi: 10.1053/j.ajkd.2008.11.034.
    1. Mittal SK, Ahern L, Flaster E, Maesaka JK, Fishbane S. Self-assessed physical and mental function of haemodialysis patients. Nephrol Dial Transplant. 2001;17:1387–1394. doi: 10.1093/ndt/16.7.1387.
    1. Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, Ray JG. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA. 2009;17:1179–1185. doi: 10.1001/jama.2009.1322.
    1. Hsu CY, Chertow GM, McCulloch CE, Fan D, Ordonez JD, Go AS. Nonrecovery of kidney function and death after acute on chronic renal failure. Clin J Am Soc Nephrol. 2009;17:891–898. doi: 10.2215/CJN.05571008.
    1. Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;17:7–20.
    1. Bell M, Granath F, Schon S, Ekbom A, Martling CR. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med. 2007;17:773–780. doi: 10.1007/s00134-007-0590-6.
    1. Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;17:1627–1638.
    1. Cartin-Ceba R, Haugen EN, Iscimen R, Trillo-Alvarez C, Juncos L, Gajic O. Evaluation of "Loss" and "End stage renal disease" after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients. Intensive Care Med. 2009;17:2087–2095. doi: 10.1007/s00134-009-1635-9.
    1. Lin YF, Ko WJ, Chu TS, Chen YS, Wu VC, Chen YM, Wu MS, Chen YW, Tsai CW, Shiao CC, Li WY, Hu FC, Tsai PR, Tsai TJ, Wu KD. NSARF Study Group. The 90-day mortality and the subsequent renal recovery in critically ill surgical patients requiring acute renal replacement therapy. Am J Surg. 2009;17:325–332. doi: 10.1016/j.amjsurg.2008.10.021.
    1. Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, Martin PY. Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int. 2006;17:1312–1317. doi: 10.1038/sj.ki.5001705.
    1. Charbonney E, Saudan P, Triverio PA, Quinn K, Mentha G, Martin PY. Prognosis of acute kidney injury requiring renal replacement therapy in solid organ transplanted patients. Transpl Int. 2009;17:1058–1063. doi: 10.1111/j.1432-2277.2009.00914.x.
    1. Jones CH, Richardson D, Goutcher E, Newstead CG, Will EJ, Cohen AT, Davison AM. Continuous venovenous high-flux dialysis in multiorgan failure: a 5-year single-center experience. Am J Kidney Dis. 1998;17:227–233. doi: 10.1053/ajkd.1998.v31.pm9469492.
    1. Darmon M, Thiery G, Ciroldi M, Porcher R, Schlemmer B, Azoulay E. Should dialysis be offered to cancer patients with acute kidney injury? Intensive Care Med. 2007;17:765–772. doi: 10.1007/s00134-007-0579-1.
    1. Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM. Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med. 1995;17:1505–1511. doi: 10.1001/archinte.1995.00430140075007.
    1. Triverio PA, Martin PY, Romand J, Pugin J, Perneger T, Saudan P. Long-term prognosis after acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant. 2009;17:2186–2189. doi: 10.1093/ndt/gfp072.
    1. McCarthy JT. Prognosis of patients with acute renal failure in the intensive-care unit: a tale of two eras. Mayo Clin Proc. 1996;17:117–126. doi: 10.4065/71.2.117.
    1. Christiansen CF, Christensen S, Johansen MB, Larsen KM, Tonnesen E, Sorensen HT. The impact of pre-admission morbidity level on 3-year mortality after intensive care: a Danish cohort study. Acta Anaesthesiol Scand. 2011;17:962–970.
    1. Pedersen CB. The Danish Civil Registration System. Scand J Public Health. 2011;17(Suppl):22–25.
    1. Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health. 2011;17(Suppl):30–33.
    1. Blichert-Hansen L, Nielsson MS, Nielsen RB, Christiansen CF, Norgaard M. Validity of the coding for intensive care admission, mechanical ventilation, and acute dialysis in the Danish National Patient Registry: a short report. Clin Epidemiol. 2013;17:9–12.
    1. Gammelager H, Christiansen CF, Johansen MB, Tonnesen E, Jespersen B, Sorensen HT. One-year mortality among Danish intensive care patients with acute kidney injury: a cohort study. Crit Care. 2012;17:R124. doi: 10.1186/cc11420.
    1. Hommel K, Rasmussen S, Madsen M, Kamper AL. The Danish Registry on Regular Dialysis and Transplantation: completeness and validity of incident patient registration. Nephrol Dial Transplant. 2010;17:947–951. doi: 10.1093/ndt/gfp571.
    1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;17(Suppl 1):S1–266.
    1. Coviello V, Boggess M. Cumulative incidence estimation in the presence of competing risks. Stata J. 2004;17:103–112.
    1. Bucaloiu ID, Kirchner HL, Norfolk ER, Hartle JE, Perkins RM. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012;17:477–485. doi: 10.1038/ki.2011.405.
    1. Ronco C, Rosner MH. Acute kidney injury and residual renal function. Crit Care. 2012;17:144. doi: 10.1186/cc11426.

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