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

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?

SUBMITTER: Truche AS

PROVIDER: S-EPMC6297118 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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

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

Annals of intensive care 20181217 1

<h4>Background</h4>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.<h4>Design</h4>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 dec ...[more]

PMID: 30560526

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Project description:Background and objectivesOlder patients in the intensive care unit are at greater risk of AKI; however, use of kidney replacement therapy in this population is poorly characterized. We describe the triggers and outcomes associated with kidney replacement therapy in older patients with AKI in the intensive care unit.Design, setting, participants, & measurementsOur study was a prospective cohort study in 16 Canadian hospitals from September 2013 to November 2015. Patients were ?65 years old, were critically ill, and had severe AKI; exclusion criteria were urgent kidney replacement therapy for a toxin and ESKD. We recorded triggers for kidney replacement therapy (primary exposure), reasons for not receiving kidney replacement therapy, 90-day mortality (primary outcome), and kidney recovery.ResultsOf 499 patients, mean (SD) age was 75 (7) years old, Charlson comorbidity score was 3.0 (2.3), and median (interquartile range) Clinical Frailty Scale score was 4 (3-5). Most were receiving mechanical ventilation (64%; n=319) and vasoactive support (63%; n=314). Clinicians were willing to offer kidney replacement therapy to 361 (72%) patients, and 229 (46%) received kidney replacement therapy. Main triggers for kidney replacement therapy were oligoanuria, fluid overload, and acidemia, whereas main reasons for not receiving therapy were anticipated recovery (67%; n=181) and therapy not consistent with patient preferences for care (24%; n=66). Ninety-day mortality was similar in patients who did and did not receive kidney replacement therapy (50% versus 51%; adjusted hazard ratio, 0.78; 95% confidence interval, 0.58 to 1.06); however, decisions to offer kidney replacement therapy varied significantly by patient mix, acuity, and perceived benefit. There were no differences in health-related quality of life or rehospitalization among survivors.ConclusionsMost older, critically ill patients with severe AKI were perceived as candidates for kidney replacement therapy, and approximately one half received therapy. Both willingness to offer kidney replacement therapy and reasons for not starting showed heterogeneity due to a range in patient-specific factors and clinician perceptions of benefit.

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

Publications

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

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