Abstract 18018: Clinical Predictors of Acute Kidney Injury After Lower Extremity Surgical Bypass in the Society for Vascular Surgery Vascular Quality Initiative

Introduction: The incidence and factors associated with acute kidney injury (AKI) development after lower extremity bypass (LEB) are not well defined. The objective of this study is to determine the incidence and characteristics associated with the development of AKI in patients undergoing infrainguinal LEB. Methods: A retrospective review of all LEB surgeries in the Vascular Quality Initiative (VQI) registry from January 2003 to April 2015 was performed. AKI was defined as post-operative rise in creatinine (Cr) > 0.5 mg/dl or new renal impairment requiring dialysis. Demographic, procedural and clinical variables were collected. Patients on dialysis and those missing pre and post-operative Cr values were excluded. Multivariate logistic regression analysis was performed to identify variables associated with the development of AKI following LEB. Results: 12,564 patients were included in the analysis; 509 (4%) developed AKI. Comparison of baseline characteristics between patients that developed AKI and those that did not are shown in the Table. In multivariate analysis, diabetes (OR 1.57, p<0.01), history of heart failure (OR 1.60, p<0.01), emergency surgery (OR 1.34, p<0.01), need for blood transfusion (OR 2.41, p<0.01) and chronic kidney disease (CKD) stages 2 (OR 1.39, p<0.01), 3(OR 2.85, p<0.01), and 4(OR 5.46, p<0.01) were all significantly associated with AKI. Factors associated with a lower incidence of AKI included smoking (OR 0.72, p<0.05), female gender (OR 0.69, p<0.01) and higher hemoglobin levels (OR 0.92, p<0.01). Conclusions: Overall, the development of AKI in a large contemporary database was 4%. Multiple clinical characteristics are associated with development of AKI, including history of heart failure, diabetes, CKD, emergency surgery and need for blood transfusion, and may help to identify at-risk patients. Further studies are needed to prospectively validate these findings and determine if postoperative AKI increases the mortality risk.

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Predictors of Acute Kidney Injury Following Surgical Valve Replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1710318 ◽

2020 ◽

Author(s):

Khalid S. Ibrahim ◽

Khalid A. Kheirallah ◽

Fadia A. Mayyas ◽

Nizar A. Alwaqfi

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Blood Transfusion ◽

Valve Replacement ◽

Artery Bypass ◽

Kidney Injury ◽

Inotropic Support ◽

History Of ◽

Surgical Valve Replacement ◽

Perioperative Blood Transfusion

Abstract Background Acute kidney injury is a serious complication after surgical valve replacement and holds increased mortality rates. Objectives To study predictors of acute kidney injury after surgical valve replacement. Materials and Methods Patients who underwent valve surgery procedures at our center were included. Procedures included aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG. Results A total of 346 patients were included. The mean age was 51.56 (16.1). Males (n = 178) comprised 51%.At the univariate level analysis, predictors of acute kidney injury were found including age, ejection fraction, hypertension, history of CAD, emergency surgery, recent myocardial infarction, diabetes, atrial fibrillation, history of heart failure, mitral regurgitation (MR), pump time >120 minutes, aortic cross clamp >90 minutes, perioperative blood transfusion, re-exploration for bleeding, use of mechanical and biologic valve in aortic position, use of biologic valve in mitral position, prolonged inotropic support, postoperative stroke, and use of angiotensin converting enzyme inhibitors (ACEi) < a month, (all p < 0.05).By Logistic regression analysis, Age (p < 0.0001, odds ratio[AOR] = 1.076), hypertension (p = 0.039, AOR = 1.829), heart failure (p = 0.019, AOR = 2.448), MR (p = 0.0001, AOR = 3.110), use of ACEi <month (p = 0.043, AOR= 2.181), pump time >120 minutes (p = 0.022, AOR = 1.797), perioperative blood transfusion (p = 0.008, AOR = 2.532), and prolonged inotropic support (p = 0.012, AOR = 2.591) were significant and independent predictors of AKI. Conclusion Independent predictors of acute kidney injury following valve surgeries include age, hypertension, heart failure, MR, use of ACEi <month, perioperative blood transfusion, and prolonged pump time or inotropic support.

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Spectrum of bacterial infections and predictors of mortality in adult cirrhotic patients

Medicine and Pharmacy Reports ◽

10.15386/mpr-1387 ◽

2019 ◽

Author(s):

Chandrashekar Udyavara Kudru ◽

Vandana Kalwaje Eshwara ◽

Shivashankara Kaniyoor Nagiri ◽

Vasudeva Guddattu

Keyword(s):

Acute Kidney Injury ◽

Hepatic Encephalopathy ◽

Ascitic Fluid ◽

Bacterial Infections ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Organ Systems ◽

Cirrhotic Patients

Introduction. Bacterial infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease and account for significant morbidity and mortality in them. Once an infection develops, it induces excessive production of pro-inflammatory cytokines leading to organ failure and death. Aims. This study aims to identify the clinical characteristics and outcome of bacterial infections affecting various organ systems in patients with liver cirrhosis and to determine factors associated with mortality. Materials and methods. A cross sectional study was performed on subjects with cirrhosis having microbiologically proven bacterial infection involving various organ systems, admitted to a tertiary care hospital in southern India. Demographic, clinical data, laboratory parameters and outcome details were noted. Univariate associations and subsequent multivariate logistic regression analysis was performed to determine factors associated with mortality. Results. The study included 158 patients. Chronic alcohol intake was the most common etiology of cirrhosis (66.4%). Community acquired infections occurred more frequently than hospital acquired infections (85.5% vs 14.5%). The common site of isolation of etiological agent was ascitic fluid (38.3%) followed by blood (24.3%), respiratory tract (15.5%) and urinary tract (14.5%). Gram negative bacterial infections were more common (74.3%), Escherichia coli being the most frequent pathogen (38.5%). Mortality was noted in 38 (24%) patients. The factors associated with mortality were the type of infection, Child Pugh category, acute kidney injury, hepatic encephalopathy, urinary tract infection, and creatinine and bilirubin levels. Multivariate logistic regression analysis revealed that type of infection (OR: 0.33, 95% CI: 0.11-1.01), ascitic fluid infection (OR: 2.81, 95% CI: 1.11-7.12), hepatic encephalopathy (OR: 0.17, 95% CI: 0.070-0.422) and acute kidney injury (OR: 0.19, 95% CI: 0.077-0.502) were significantly associated with in-hospital mortality. Conclusion. This study indicates that the type of infection, hepatic encephalopathy, ascitic fluid infection and acute kidney injury are associated with mortality in cirrhotic patients. Early effective treatment and prevention of these complications may help modify the outcome.

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Effect of acute kidney injury on hospital-based outcomes in patients with multiple myeloma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e20006 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e20006-e20006

Author(s):

Muhammad Usman Zafar ◽

Zahid Tarar ◽

Ghulam Ghous ◽

Umer Farooq ◽

Bradley Walter Lash

Keyword(s):

Heart Failure ◽

Multiple Myeloma ◽

Acute Kidney Injury ◽

Length Of Stay ◽

Kidney Injury ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Teaching Hospitals ◽

Inpatient Mortality ◽

History Of

e20006 Background: Multiple Myeloma, a cancer of plasma cells, is treatable, but incurable. 5-year survival rate is about 54% depending upon the stage. Studies have suggested that up to 50% of the patients experience acute kidney injury or chronic kidney disease at some point in their disease course. Approximately 3% of the patients will end up on hemodialysis. In this study we utilize the National Inpatient Sample (NIS) to understand the effect of acute kidney injury (AKI) on inpatient mortality in multiple myeloma patients. Methods: This is a retrospective study utilizing the data obtained from the NIS for the year 2018. We queried this NIS database for ICD-10 codes for multiple myeloma or plasmacytoma that had not achieved remission or was in relapse. We also looked at codes for acute kidney injury as secondary diagnosis. Primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay and cost utilization. We then ran multivariate logistic regression analysis in STATA MP 16.1. Various comorbidities were accounted for by adding them into the analysis. These included previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, stem cell transplant, neutropenia and chemotherapy. Results: The population of multiple myeloma patients under investigation were all adults more than 18 years of age and numbered in 3944 patients. The mean age was 65.71 years. Among these 45% were females. While examining inpatient mortality we see that for patients that had AKI the odds of inpatient mortality are higher (Odds Ratio (OR) 1.75, p = 0.003, 95% Confidence Interval (CI) 1.21 – 2.56). History of Heart Failure (OR 2.28, 95% CI 1.59 – 3.28), and increasing age (OR 1.02, 95% CI 1.01 – 1.04) also appear to contribute towards higher odds of mortality. The effect of other comorbidities was not statistically significant. Among demographical characteristics being of Native American heritage or not belonging to any descriptive race predicted higher odds of mortality. Mean LOS was 11 days. Patients with AKI stayed in the hospital longer by ̃1.4 days (Coef. 1.39, 95% CI 0.41 – 2.37). LOS was higher in patients with a history of heart failure (2.61, 95% CI 0.89 – 4.34 and in those with a history of neutropenia (5.52, 95% CI 4.42 – 6.62). LOS was lower in patients with a history of smoking by 1 day. Age lowered the LOS by a clinically insignificant amount. Teaching hospitals had higher LOS by ̃4 days. The total charge for hospitalizations from AKI is higher by $31019 (95% CI 14444.23 – 47594.37). Other factors incurring higher cost include history of neutropenia, and teaching hospitals. Hospitals in the Midwest had lower cost compared to hospitals in the Northeast. Conclusions: Among patients that present with a principal diagnosis of multiple myeloma, having acute kidney injury, adversely affects inpatient outcomes that include, mortality, hospital length of stay and total hospitalization cost.

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Abstract 16705: Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter

Circulation ◽

10.1161/circ.142.suppl_3.16705 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Zaniar Ghazizadeh ◽

Chad Gier ◽

Avinainder Singh ◽

Lina Vadlamani ◽

Maxwell Eder ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Acute Kidney Injury ◽

Adverse Events ◽

Cardiac Injury ◽

Kidney Injury ◽

Prior History ◽

New Haven ◽

History Of ◽

Record Review

Introduction: The prevalence and outcomes of patients hospitalized with COVID-19 with atrial fibrillation and atrial flutter (AF/FL) remains unclear. Methods: The Yale Cardiovascular COVID Registry is a cohort study of adult patients >=18 years hospitalized with COVID-19 in the Yale New Haven Health System. Retrospective medical record review was performed on consecutive patients from the registry admitted between March and June 2020. We calculated the rates of prior and in-hospital AF/FL and evaluated the unadjusted rates of in-hospital adverse events for both groups; we then calculated the adjusted odds of adverse events using logistic regression. Results: Among 396 patients, the mean age was 68.2, 52.3% were men, 56.4% were Caucasian, 28.4% Black and 16.9% Hispanic. 15.7% of patients had prior history of AF/FL. 19.9% of patients had in-hospital AF/FL, 7.83% of which did not have a prior history of AF/FL. Patients with in-hospital AF/FL had significantly more CV complications compared to those without including cardiac injury (78.5% vs 42.7%, p=0.000), type 2 myocardial infarction (53.3 vs 30.3%, p=0.002), and heart failure (32.9% vs 9.2%, p=0.000). In-hospital AF/FL was associated with significantly worse outcomes related to COVID-19 including ICU survival (OR 0.22 [0.08-0.59], p=0.002), heart failure (5.19 [2.56-10.5], p=0.000), myocardial injury (OR 2.87 [1.49-5.49], p=0.001), acute kidney injury (OR 2.02 [1.09-3.74], p=0.027), dialysis (OR 4.07 [1.38-12.03], p=0.011) and hospice/death (OR 2.47 [1.35-4.53], p=0.004). Conclusion: AF/FL are common in patients hospitalized with COVID-19 and these patients had significantly worse outcomes, including lower odds of ICU survival and higher odds of heart failure, acute kidney injury, dialysis and hospice/death.

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Factors and Outcomes of Persistent Pulmonary Hypertension of the Newborn Associated with Acute Kidney Injury in Thai Neonates

American Journal of Perinatology ◽

10.1055/s-0037-1607213 ◽

2017 ◽

Vol 35 (03) ◽

pp. 298-304 ◽

Cited By ~ 2

Author(s):

Wuttichart Kamolvisit ◽

Sutthikiat Jaroensri ◽

Benthira Ratchatapantanakorn ◽

Narongsak Nakwan

Keyword(s):

Acute Kidney Injury ◽

Pulmonary Hypertension ◽

Urine Output ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Persistent Pulmonary Hypertension ◽

Factors Associated ◽

Increased Risk ◽

Stage 1

Objective This study aims to determine the risk factors and outcome of persistent pulmonary hypertension of the newborn (PPHN)-associated acute kidney injury (AKI). Study Design Infants diagnosed with PPHN at Hat Yai Hospital from January 2012 to December 2016 were retrospectively reviewed. Results Of the 109 included PPHN infants, 28.4% (31/109) died, and AKI was found in 28.4% following neonatal KDIGO classification. Of the 31, 19 who died (61.3%) reached stage 1, 3 (9.7%) reached stage 2, and 9 (29.0%) reached stage 3. AKI (all stages combined) was significantly associated with increased mortality with an odds ratio (OR) of 8.71 (95% confidence interval [CI], 3.37–22.49). Multivariate logistic regression analysis indicated that male gender (adjusted OR = 8.56; 95% CI = 0.84–85.09) and urine output of < 1 mL/kg/h in 12 hours of admission (adjusted OR = 15.57; 95% CI = 2.58–93.98) were the main factors associated with an increased risk for AKI, while birth by cesarean delivery was associated with reduced risk of AKI (adjusted OR = 0.10; 95% CI = 0.16–0.68). Conclusion The incidence of AKI in PPHN was high in this study, and this complication was also significantly associated with higher mortality. In PPHN neonates, AKI should be especially closely monitored in males and infants who have a urine output of < 1 mL/kg/h in the first 12 hours of admission.

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Pathogenetic mechanisms, epidemiology and classification of acute kidney injury in heart transplant recipients

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2021-2-147-157 ◽

2021 ◽

Vol 23 (2) ◽

pp. 147-157

Author(s):

I. L. Poz ◽

A. G. Strokov ◽

V. N. Poptsov ◽

A. O. Shevchenko ◽

S. V. Gautier

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Heart Transplant ◽

Kidney Injury ◽

Complex Nature ◽

Transplant Recipients ◽

Kidney Dysfunction ◽

Factors Associated ◽

Heart Transplant Recipients

Kidney injury in heart transplant recipients is of a complex nature and bears the features of all types of cardiorenal interaction impairment. Pre-transplant renal dysfunction, perioperative acute kidney injury, as well as factors associated with graft and immunosuppression, determine the prevalence and severity of kidney pathology in this group of patients. This review examines the pathophysiology of kidney dysfunction in heart failure, the epidemiology, and criteria for acute kidney injury.

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Association of the classification and severity of heart failure with the incidence of contrast-induced acute kidney injury

Scientific Reports ◽

10.1038/s41598-021-94910-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tian Xu ◽

Maoning Lin ◽

Xiaohua Shen ◽

Min Wang ◽

Wenjuan Zhang ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Acute Kidney Injury ◽

Risk Factor ◽

Independent Risk Factor ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Baseline Creatinine ◽

Independent Risk Factors ◽

Relationship Of

AbstractCongestive heart failure (HF) is a known risk factor of contrast-induced acute kidney injury (CI-AKI). However, the relationship of the classification and severity of HF with CI-AKI remains under-explored. From January 2009 to April 2019, we recruited patients undergoing elective PCI who had complete pre- and post-operative creatinine data. According to the levels of ejection fraction (EF), HF was classified as HF with reduced EF (HFrEF) [EF < 40%], HF with mid-range EF (HFmrEF) [EF 40–49%] and HF with preserved EF (HFpEF) [EF ≥ 50%]. CI-AKI was defined as an increase of either 25% or 0.5 mg/dL (44.2 μmoI/L) in serum baseline creatinine level within 72 h following the administration of the contrast agent. A total of 3848 patients were included in the study; mean age 67 years old, 33.9% females, 48.1% with HF, and 16.9% with CI-AKI. In multivariate logistic regression analysis, HF was an independent risk factor for CI-AKI (OR 1.316, p value < 0.05). Among patients with HF, decreased levels of EF (OR 0.985, p value < 0.05) and elevated levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) (OR 1.168, p value < 0.05) were risk factors for CI-AKI. These results were consistent in subgroup analysis. Patients with HFrEF were more likely to develop CI-AKI than those with HFmrEF or HFpEF (OR 0.852, p value = 0.031). Additionally, lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group. NT-proBNP was an independent risk factor for CI-AKI in the HFrEF, HFmrEF and HFpEF groups. Elevated levels of NT-proBNP are independent risk factors for CI-AKI irrespective of the classification of HF. Lower levels of EF were risk factors for CI-AKI in the HFrEF and HFmrEF groups, but not in the HFpEF group.

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Abstract 17300: Acute Kidney Injury is Associated With High Mortality in Patients With Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.17300 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Siva Harsha Yedlapati ◽

Usman Younus ◽

Scott H Stewart

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Acute Kidney Injury ◽

Hospital Mortality ◽

High Mortality ◽

Mortality Risk ◽

Odds Ratio ◽

Kidney Injury ◽

The United States ◽

Factors Associated

Introduction: The prevalence of atrial fibrillation (AF) is high in patients with chronic kidney disease (CKD). The mortality risk of AF in the presence of CKD is also significantly high. Multiple theories of which importantly, the renin-angiotensin-aldosterone system activation causing increased ventricular remodeling and heart failure, explain the increased incidence of AF in CKD. However, there are no data available on the effects of acute kidney injury (AKI) on mortality in patients with AF. We sought to investigate the prevalence and association of AKI with in-hospital mortality in patients presenting with AF. Methods: We performed a cross-sectional analysis of the 2011 Nationwide Inpatient Sample (NIS). Using logistic regression methods appropriate for the NIS sample design, we estimated the mortality risk associated with AKI in AF patients and evaluated factors that might modify this association. Results: In 2011, AF accounted for 457662 (1.4%) of overall adult admissions in the United States with an in-hospital mortality rate of 1%. Among these hospitalizations 30894 (6.8%) had a concomitant AKI diagnosis. The prevalence of AKI was higher (38%) in patients who died during these AF hospitalizations. The mortality risk in AF hospitalizations with an AKI diagnosis remained high even after adjusting for factors associated with AKI including age, sex, CKD, sepsis, hypertension, diabetes, congestive heart failure (CHF), smoking and heavy alcohol use (odds ratio 5.6; 95% CI (4.7 - 6.6); P<0.0001), relative to patients hospitalized with a non-AF diagnoses (odds ratio 3.3; 95% CI (3.2 - 3.4). The factors that interacted with AKI in predicting mortality risk in AF hospitalizations were underlying CKD, CHF, diabetes and alcoholism. Conclusion: Among hospitalized patients with AF, AKI is associated with significantly high mortality. This mortality was higher when compared to patients hospitalized with a non-AF diagnosis. Interpretation of our results must be conservative given the study design and data limitations. Future research using primary data sources might help identify factors associated with increased mortality in AKI patients presenting with AF.

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Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

Cardiorenal Medicine ◽

10.1159/000509182 ◽

2020 ◽

Vol 10 (4) ◽

pp. 223-231 ◽

Cited By ~ 7

Author(s):

Jerald Pelayo ◽

Kevin Bryan Lo ◽

Ruchika Bhargav ◽

Fahad Gul ◽

Eric Peterson ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

African American ◽

Clinical Outcomes ◽

Clinical Characteristics ◽

Kidney Injury ◽

Hospital Death ◽

City Hospital ◽

History Of ◽

Hospital Acquired

Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121–13.231, p = 0.032). Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

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Frailty status among older critically ill patients with severe acute kidney injury

Critical Care ◽

10.1186/s13054-021-03510-y ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

William Beaubien-Souligny ◽

Alan Yang ◽

Gerald Lebovic ◽

Ron Wald ◽

Sean M. Bagshaw

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Multivariable Analysis ◽

Kidney Injury ◽

Multivariable Logistic Regression Analysis ◽

Clinical Frailty Scale ◽

Factors Associated ◽

Frailty Status ◽

Physiological Variables

Abstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.

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