scholarly journals Acute kidney disease and long-term outcomes in critically ill acute kidney injury patients with sepsis: a cohort analysis

2020 ◽  
Author(s):  
Joana Gameiro ◽  
Carolina Carreiro ◽  
José Agapito Fonseca ◽  
Marta Pereira ◽  
Sofia Jorge ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Hospital Discharge ◽  
Kidney Injury ◽  
Renal Outcomes ◽  
Acute Kidney Disease ◽  
Long Term Mortality

Abstract Background Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse short- and long-term consequences. Acute kidney disease (AKD) reflects the continuing pathological processes and adverse events developing after AKI. We aimed to evaluate the association of AKD, long-term adverse renal function and mortality in a cohort of patients with sepsis. Methods We performed a retrospective analysis of adult patients with septic AKI admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Patients were categorized according to the development of AKI using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. AKD was defined as presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. Results From 256 selected patients with septic AKI, 53.9% developed AKD. The 30-day mortality rate was 24.5% (n = 55). The mean long-term follow-up was 45.9 ± 43.3 months. The majority of patients experience an adverse renal outcome [n = 158 (61.7%)] and 44.1% (n = 113) of patients died during follow-up. Adverse renal outcomes, 30-day mortality and long-term mortality after hospital discharge were more frequent among AKD patients [77.5 versus 43.2% (P < 0.001), 34.1 versus 6.8% (P < 0.001) and 64.8 versus 49.1% (P = 0.025), respectively]. The 5-year cumulative probability of survival was 23.2% for AKD patients, while it was 47.5% for patients with no AKD (log-rank test, P < 0.0001). In multivariate analysis, AKD was independently associated with adverse renal outcomes {adjusted hazard ratio [HR] 2.87 [95% confidence interval (CI) 2.0–4.1]; P < 0.001} and long-term mortality [adjusted HR 1.51 (95% CI 1.0–2.2); P = 0.040]. Conclusions AKD after septic AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge.

scholarly journals P0564INCIDENCE AND PROGNOSIS OF ACUTE KIDNEY INJURY VERSUS ACUTE KIDNEY DISEASE AMONG 71,041 INPATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chenyu Li ◽  
Long Zhao ◽  
Lingyu Xu ◽  
Chen Guan ◽  
Zhibo Zhao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Kidney Function ◽  
De Novo ◽  
Kidney Injury ◽  
Acute Kidney Disease ◽  
Long Term Mortality

Abstract Background and Aims The current diagnostic criteria for acute kidney injury (AKI) predict the need for dialysis and early mortality, but are less useful to predict long-term outcomes. Acute kidney disease (AKD) defines patients with AKI or subacute loss of kidney function lasting for more than 7 days, which should predict better subsequent chronic kidney disease (CKD). The aim of this study was to investigate the risk factors and prognosis of AKD and to compare different types of acute/subacute renal impairment among Chinese inpatients. Method From a cohort of 450,000 patients consecutive admitted from June 1, 2012, to March 31, 2018 to five district hospitals, complete data were available from 71,041 inpatients. AKI and AKD were diagnosed based on the Acute Disease Quality Initiative Criteria 2017. Based on this diagnostic criterion of AKI and AKD, patients were classified as having (1) AKI Recover, if Scr back to baseline value within 7 days (renal impairment duration of less than 7 days or rapid recovery within 7 days), and (2) AKD with AKI, if a condition in which stage 1 or greater AKI was present ≥ 7 days after an AKI initiating event (continuous AKI progressing to AKD), (3) AKD without AKI, if Scr levels increased slowly but lasted more than 7 days (subacute AKD without meeting the AKI criterion). Results Of 71,041 inpatients, 16,098 (22.66%) patients developed AKI or AKD. 5,895 (8.30%) AKI patients recovered within 7 days (AKI Recover), 5,623 (7.91%) were followed by AKD and 4,580 (6.44%) patients developed AKD without AKI. Thus, AKI and AKD are frequent complications in Chinese inpatients (Fig 1). Compared to AKI recover or AKD without AKI, patients with AKI followed by AKD had higher hospital mortality (16.59% vs. 3.82% vs. 2.12%, P<0.05) and more de novo CKD (8.95% vs. 7.29% vs. 5.48%, P<0.05). Mortality was proportional to stages of AKI and AKD (P for trend <0.05), while AKI followed by AKD was associated with a higher risk of long-term mortality (hazard ratio (HR) 4.51, 4.32-4.71, P<0.05) as compared to AKD without AKI (HR 2.25, 2.13-2.39, P<0.05) and AKI Recover (HR 1.18, 1.09-1.26, P<0.05). The AKI criterion yielded a higher risk for overall survival and a lower risk for de novo CKD than the AKD criterion, indicating that both criteria imply persistent kidney damage but that a rapid decline in excretory kidney function implies higher mortality risks while a persistent decline may rather result in de novo CKD (Fig 2). Meanwhile, these associations between different kidney injury criteria and outcomes had good generalizability and were constant across different genders, surgeries, and comorbidities (Fig 2). The AKD criterion was robustly associated with overall survival (area under the receiver operating characteristic curve (AUROC) 0.71) and de novo CKD (AUROC 0.71), while AKI criterion showed a relatively lower ability to fitting risk of overall survival (AUROC 0.65, P<0.05) and CKD (AUROC 0.63, P<0.05). Moreover, combining AKI and AKD was strongly associated with long-term mortality (AUROC 0.725) and de novo CKD (AUROC 0.72) compared to each single criterion of AKI or AKD (Fig 3). Conclusion (1) Adding AKD as a definition for renal failure lasting >7 days up to 90 days is of clinical importance in addition to the existing definitions for AKI and CKD. (2) These findings suggest research activities and clinical practice should also focus on AKD, which is far more accurate to predict subsequent de novo CKD.

Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes

2021 ◽  
pp. postgradmedj-2020-139021
Author(s):  
Manoj Kumar ◽  
Maasila Arcot Thanjan ◽  
Natarajan Gopalakrishnan ◽  
Dhanapriya Jeyachandran ◽  
Dineshkumar Thanigachalam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Long Term Outcomes ◽  
Urine Protein ◽  
Renal Outcomes ◽  
Snake Envenomation ◽  
The Mean ◽  
New Onset

BackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

scholarly journals Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Medicine ◽  
2015 ◽  
Vol 94 (45) ◽  
pp. e2025 ◽  
Author(s):  
Jia-Rui Xu ◽  
Jia-Ming Zhu ◽  
Jun Jiang ◽  
Xiao-Qiang Ding ◽  
Yi Fang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Long Term Mortality

P0602CLINICAL PATTERN, RENAL RECOVERY AND PATIENT OUTCOMES AFTER ACUTE KIDNEY INJURY IN ADULTS IN AN EMERGING COUNTRY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Arunkumar Subbiah ◽  
Sanjay Kumar Agarwal
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Renal Recovery ◽  
Common Source ◽  
Partial Recovery

Abstract Background and Aims Acute Kidney Injury (AKI) is an important determinant of outcome in hospitalized patients. Further, there is a risk for development of Chronic Kidney Disease (CKD) in the future. Though the long-term impact of AKI has been studied in developed countries, there is a paucity of data in this area from the Indian subcontinent. This single-centre study aimed to assess the pattern, clinical spectrum, short-term and long-term outcomes of AKI. Method In this prospective observational cohort study, detailed demographic and clinical data at presentation, during hospital stay and follow-up at 1, 3, 6 and 12 months after discharge were obtained prospectively for a cohort of patients with AKI. Both community (CAAKI) and hospital acquired AKI (HAAKI) were included. Patient with pre-existing CKD were excluded. Outcome variables examined were in-hospital mortality, renal function at discharge and on follow-up after discharge from hospital. Results In our study cohort with 476 patients, majority of the cases were CAAKI (395, 83%). The mean age at presentation was 44.8 ± 18.7 years. Medical causes (84%) contributed to the majority of AKI while the remaining were due to surgical (10%) and obstetrical (6%) causes. Sepsis (176/476; 36.9%) was the most common cause of AKI. The most common source for sepsis was respiratory (41%) followed by urological source (18.7%). The in-hospital mortality rate for patients with AKI was 38%. Age &gt;60 years (HR = 1.51; 95% CI, 1.11 – 2.07), oliguria (HR = 1.48; 95% CI, 1.05 – 2.10), need for ventilator (HR = 2.45; 95% CI, 1.36 – 4.41) and/or inotropes (HR = 14.4; 95% CI, 6.28 – 33.05) were predictors of mortality. At discharge, 146 (30.7%) patients had complete renal recovery, while 149 (31.3%) had partial renal recovery. Oliguria (p &lt; 0.001), hypoalbuminemia (p = 0.001) and need for renal replacement therapy (RRT) (p = 0.01) were significantly associated with partial recovery. Of the 295 patients on follow-up at discharge, 211 (71.5%) patients had normal renal function, 4 (1.4%) died and 33 (11.2%) were lost to follow up; 47(15.9%) patients developed CKD of which 6 (2%) were dialysis dependent. Elderly patients, higher AKIN stage with oliguria and those requiring RRT were more likely to develop CKD. Among these, the need for in-hospital RRT was the single most important factor predicting the risk of CKD (OR 1.77, 95% CI, 1.12-2.78). Conclusion In conclusion, our data shows that AKI in hospitalized patients still has high mortality in emerging countries like India. Though a fairly good percentage of cases recovered, there is a definite risk of CKD development, especially in patients who required RRT during hospitalization.

scholarly journals Continued monitoring of acute kidney injury survivors might not be necessary in those regaining an estimated glomerular filtration rate >60 mL/min at 1 year

2017 ◽  
Vol 32 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Sokratis Stoumpos ◽  
Patrick B. Mark ◽  
Emily P. McQuarrie ◽  
Jamie P. Traynor ◽  
Colin C. Geddes
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Normal Renal Function ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Injury ◽  
Risk Of Progression

Background. Severe acute kidney injury (AKI) among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who recover to normal renal function. The aim of this study was to determine the long-term renal outcome of patients experiencing AKI requiring dialysis secondary to hypoperfusion injury and/or sepsis who recovered to apparently normal renal function. Methods. All adult patients with AKI requiring dialysis in our centre between 1 January 1980 and 31 December 2010 were identified. We included patients who had estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2 12 months or later after the episode of AKI. Patients were followed up until 3 March 2015. The primary outcome was time to chronic kidney disease (CKD) (defined as eGFR persistently <60 mL/min/1.73 m2) from first dialysis for AKI. Results. Among 2922 patients with a single episode of dialysis-requiring AKI, 396 patients met the study inclusion criteria. The mean age was 49.8 (standard deviation 16.5) years and median follow-up was 7.9 [interquartile range (IQR) 4.8–12.7] years. Thirty-five (8.8%) of the patients ultimately developed CKD after a median of 5.3 (IQR 2.8–8.0) years from first dialysis for AKI giving an incidence rate of 1 per 100 person-years. Increasing age, diabetes and vascular disease were associated with higher risk of progression to CKD [adjusted hazard ratios (95% confidence interval): 1.06 (1.03, 1.09), 3.05 (1.41, 6.57) and 3.56 (1.80, 7.03), respectively]. Conclusions. Recovery from AKI necessitating in-hospital dialysis was associated with a very low risk of progression to CKD. Most of the patients who progressed to CKD had concurrent medical conditions meriting monitoring of renal function. Therefore, it seems unlikely that regular follow-up of renal function is beneficial in patients who recover to eGFR >60 mL/min/1.73 m2 by 12 months after an episode of AKI.

scholarly journals Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury

2021 ◽  
Vol 10 (24) ◽  
pp. 5760
Author(s):  
Filippo Mariano ◽  
Consuelo De Biase ◽  
Zsuzsanna Hollo ◽  
Ilaria Deambrosis ◽  
Annalisa Davit ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Kidney Injury ◽  
Burn Patients ◽  
Urine Protein ◽  
Urine Albumin

Background. The real impact of septic shock-associated acute kidney injury (AKI) on the long-term renal outcome is still debated, and little is known about AKI-burn patients. In a cohort of burn survivors treated by continuous renal replacement therapy (CRRT) and sorbent technology (CPFA-CRRT), we investigated the long-term outcome of glomerular and tubular function. Methods. Out of 211 burn patients undergoing CRRT from 2001 to 2017, 45 survived, 40 completed the clinical follow-up (cumulative observation period 4067 months, median 84 months, IR 44-173), and 30 were alive on 31 December 2020. Besides creatinine and urine albumin, in the 19 patients treated with CPFA-CRRT, we determined the normalized GFR by 99mTc-DTPA (NRI-GFR) and studied glomerular and tubular urine protein markers. Results. At the follow-up endpoint, the median plasma creatinine and urine albumin were 0.99 (0.72–1.19) and 0.0 mg/dL (0.0–0.0), respectively. NRI-GFR was 103.0 mL/min (93.4–115). Four patients were diabetic, and 22/30 presented at least one risk factor for chronic disease (hypertension, dyslipidemia, and overweight). Proteinuria decreased over time, from 0.47 g/day (0.42–0.52) at 6 months to 0.134 g/day (0.09–0.17) at follow-up endpoint. Proteinuria positively correlated with the peak of plasma creatinine (r 0.6953, p 0.006) and the number of CRRT days (r 0.5650, p 0.035) during AKI course, and negatively with NRI–GFR (r −0.5545, p 0.049). In seven patients, urine protein profile showed a significant increase of glomerular marker albumin and glomerular/tubular index. Conclusions. Burn patients who experienced septic shock and AKI treated with CRRT had a long-term expectation of preserved renal function. However, these patients were more predisposed to microalbuminuria, diabetes, and the presence of risk factors for intercurrent comorbidities and chronic renal disease.

The Long-Term Outcomes of Acute Kidney Injury

2014 ◽  
Author(s):  
Ron Wald ◽  
Ziv Harel
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Epidemiologic Studies ◽  
High Risk Group ◽  
Long Term Outcomes ◽  
Post Discharge

Recent research has provided important insights on the long-term outcomes of patients who develop acute kidney injury (AKI) in the setting of critical illness. Large epidemiologic studies have demonstrated compelling associations between episodes of AKI and progressive kidney disease and death, respectively, although such studies do not establish causality due to the potential for confounding. Whether AKI is intrinsically toxic or a mere by-product of serious comorbidities (e.g. prior chronic kidney disease, heart failure, diabetes), there is no doubt that AKI survivors are a high-risk group who would likely benefit from close post-discharge follow-up. Recent studies have shown that a minority of patients with AKI receive specialized nephrology follow-up after discharge, suggesting an opportunity for quality improvement. Emerging research is evaluating factors that predict chronic kidney disease, end-stage renal disease, and death among AKI survivors. This work will, it is hoped, suggest new targets for prevention and treatment, with the goal of enhancing the likelihood of recovery following AKI.

scholarly journals Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Eduesley Santana-Santos ◽  
Felipe Kenji Oshiro Kamei ◽  
Tarcísia Karoline do Nascimento ◽  
Anas Abou Ismail ◽  
Jurema da Silva Herbas Palomo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Kidney Injury ◽  
Perioperative Period

Background. Acute kidney injury (AKI) is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD), are not known.Methods. We compared the long-term prognoses of CKD patients who developed (n=23) and did not develop (n=35) AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG). Fifty-eight patients who survived (69.6±8.4years old, 72% males, 83% Whites, 52% diabetics, baseline GFR:46±16 mL/min) were followed up for47.8±16.4months and treated for secondary prevention of events.Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI− group (Log-rank = 0.218), two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI− patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up.Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.

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