Kidney function decline after a non-dialysis-requiring acute kidney injury is associated with higher long-term mortality in critically ill survivors

• Published in: Critical care (London, England) England), 2012-07, Vol.16 (4), p.R123-R123, Article R123
• Main Authors: Lai, Chun-Fu, Wu, Vin-Cent, Huang, Tao-Min, Yeh, Yu-Chang, Wang, Kuo-Chuan, Han, Yin-Yi, Lin, Yu-Feng, Jhuang, Ying-Jheng, Chao, Chia-Ter, Shiao, Chih-Chung, Tsai, Pi-Ru, Hu, Fu-Chang, Chou, Nai-Kuan, Ko, Wen-Je, Wu, Kwan-Dun
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - mortality; Acute Kidney Injury - physiopathology; Acute Kidney Injury - therapy; Acute renal failure; Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Chronic kidney failure; Comorbidity; Creatinine - blood; Critical Illness; Critically ill; Disease Progression; Female; Health aspects; Hospital Mortality; Humans; Intensive Care Units; Kidney Failure, Chronic - epidemiology; Kidney Function Tests; Male; Middle Aged; Prognosis; Retrospective Studies; Survival Analysis; Survivors; Taiwan - epidemiology; Treatment Outcome
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/cc11419

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