Association of persistent acute kidney injury and renal recovery with mortality in hospitalised patients

ObjectivesAcute kidney injury (AKI) affects up to one-quarter of hospitalised patients and 60% of patients in the intensive care unit (ICU). We aim to understand the baseline characteristics of patients who will develop distinct AKI trajectories, determine the impact of persistent AKI and renal non-recovery on clinical outcomes, resource use, and assess the relative importance of AKI severity, duration and recovery on survival.MethodsIn this retrospective, longitudinal cohort study, 156 699 patients admitted to a quaternary care hospital between January 2012 and August 2019 were staged and classified (no AKI, rapidly reversed AKI, persistent AKI with and without renal recovery). Clinical outcomes, resource use and short-term and long-term survival adjusting for AKI severity were compared among AKI trajectories in all cohort and subcohorts with and without ICU admission.ResultsFifty-eight per cent (31 500/54 212) had AKI that rapidly reversed within 48 hours; among patients with persistent AKI, two-thirds (14 122/22 712) did not have renal recovery by discharge. One-year mortality was significantly higher among patients with persistent AKI (35%, 7856/22 712) than patients with rapidly reversed AKI (15%, 4714/31 500) and no AKI (7%, 22 117/301 466). Persistent AKI without renal recovery was associated with approximately fivefold increased hazard rates compared with no AKI in all cohort and ICU and non-ICU subcohorts, independent of AKI severity.DiscussionAmong hospitalised, ICU and non-ICU patients, persistent AKI and the absence of renal recovery are associated with reduced long-term survival, independent of AKI severity.ConclusionsIt is essential to identify patients at risk of developing persistent AKI and no renal recovery to guide treatment-related decisions.

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Renal recovery and long-term survival following acute kidney injury after coronary artery surgery: a nationwide study

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.12758 ◽

2016 ◽

Vol 60 (9) ◽

pp. 1230-1240 ◽

Cited By ~ 21

Author(s):

S. Helgadottir ◽

M. I. Sigurdsson ◽

R. Palsson ◽

D. Helgason ◽

G. H. Sigurdsson ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Artery ◽

Kidney Injury ◽

Renal Recovery ◽

Coronary Artery Surgery ◽

Term Survival ◽

Long Term Survival ◽

Nationwide Study

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Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

British Journal Of Nutrition ◽

10.1017/s000711451900271x ◽

2019 ◽

Vol 123 (3) ◽

pp. 337-346 ◽

Cited By ~ 1

Author(s):

Chenyu Li ◽

Lingyu Xu ◽

Chen Guan ◽

Long Zhao ◽

Congjuan Luo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nutritional Status ◽

Cox Regression ◽

Kidney Injury ◽

Nutritional Risk ◽

Term Survival ◽

Long Term Survival ◽

Hospitalised Patients ◽

Nrs 2002

AbstractMalnutrition and acute kidney injury (AKI) are common complications in hospitalised patients, and both increase mortality; however, the relationship between them is unknown. This is a retrospective propensity score matching study enrolling 46 549 inpatients, aimed to investigate the association between Nutritional Risk Screening 2002 (NRS-2002) and AKI and to assess the ability of NRS-2002 and AKI in predicting prognosis. In total, 37 190 (80 %) and 9359 (20 %) patients had NRS-2002 scores <3 and ≥3, respectively. Patients with NRS-2002 scores ≥3 had longer lengths of stay (12·6 (sd 7·8) v. 10·4 (sd 6·2) d, P < 0·05), higher mortality rates (9·6 v. 2·5 %, P < 0·05) and higher incidence of AKI (28 v. 16 %, P < 0·05) than patients with normal nutritional status. The NRS-2002 showed a strong association with AKI, that is, the risk of AKI changed in parallel with the score of the NRS-2002. In short- and long-term survival, patients with a lower NRS-2002 score or who did not have AKI achieved a significantly lower risk of mortality than those with a high NRS-2002 score or AKI. Univariate Cox regression analyses indicated that both the NRS-2002 and AKI were strongly related to long-term survival (AUC 0·79 and 0·71) and that the combination of the two showed better accuracy (AUC 0·80) than the individual variables. In conclusion, malnutrition can increase the risk of AKI and both AKI and malnutrition can worsen the prognosis that the undernourished patients who develop AKI yield far worse prognosis than patients with normal nutritional status.

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