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Observational Study
, 16 (4), R123

Kidney Function Decline After a Non-Dialysis-Requiring Acute Kidney Injury Is Associated With Higher Long-Term Mortality in Critically Ill Survivors

Observational Study

Kidney Function Decline After a Non-Dialysis-Requiring Acute Kidney Injury Is Associated With Higher Long-Term Mortality in Critically Ill Survivors

Chun-Fu Lai et al. Crit Care.

Abstract

Introduction: The adverse consequences of a non-dialysis-requiring acute kidney injury (AKI) are unclear. This study aimed to assess the long-term prognoses for critically ill patients experiencing a non-dialysis-requiring AKI.

Methods: This retrospective observational cohort study investigated non-dialysis-requiring AKI survivors in surgical intensive care units between January 2002 and June 2010. All longitudinal post-discharge serum creatinine measurements and information regarding end-stage renal disease (ESRD) and death were collected. We assessed the long-term outcomes of chronic kidney disease (CKD), ESRD and all-cause mortality beyond discharge.

Results: Of the 922 identified critically ill patients with a non-dialysis-requiring AKI, 634 (68.8%) patients who survived to discharge were enrolled. A total of 207 patients died after a median follow-up of 700.5 days. The median intervals between the onset of the AKI and the composite endpoints "stage 3 CKD or death", "stage 4 CKD or death", "stage 5 CKD or death", and "ESRD or death" were 685, 1319, 1743, and 2048 days, respectively. This finding shows a steady long-term decline in kidney function after discharge. Using the multivariate Cox proportional hazard model, we found that every 1 mL/min/1.73 m2 decrease from baseline estimated glomerular filtration rate (eGFR) of individuals who progressed to stage 3, 4, and 5 CKD increased the risks of long-term mortality by 0.7%, 2.3%, and 4.1%, respectively (all p < 0.05). This result indicates that the mortality risk increased significantly in a graded manner as kidney function declined from the baseline eGFR to advanced stages of CKD during the follow-up period.

Conclusions: In critically ill patients who survive a non-dialysis-requiring AKI, there is a need for continuous monitoring and kidney function protection beyond discharge.

Figures

Figure 1
Figure 1
The Kaplan-Meier survival curve for time (days) from AKI onset to long-term outcomes. (A) Time to stage 3 to 5 CKD or ESRD; (B) time to all-cause mortality; (C) time to composite outcomes of "stage 3 CKD or death", "stage 4 CKD or death", "stage 5 CKD or death", and "ESRD or death". AKI: acute kidney injury; CKD: chronic kidney disease; ESRD: end-stage renal disease.

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