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

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.

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

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139021 ◽

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.

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Long-Term Outcome After Renal Replacement Therapy in Severe Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa034 ◽

2020 ◽

Vol 41 (4) ◽

pp. 866-870

Author(s):

Ilmari Rakkolainen ◽

Kukka-Maaria Mustonen ◽

Jyrki Vuola

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Burn Injury ◽

Kidney Injury ◽

Term Outcome ◽

Long Term Outcome ◽

Discharged Patients

Abstract Acute kidney injury is a common sequela after major burn injury, but only a small proportion of patients need renal replacement therapy. In the majority of patients, need for renal replacement therapy subsides before discharge from the burn center but limited literature exists on long-term outcomes. A few studies report an increased risk for chronic renal failure after burn injury. We investigated the long-term outcome of severely burned patients receiving renal replacement therapy during acute burn injury treatment. Data on 68 severely burned patients who received renal replacement therapy in Helsinki Burn Centre between November 1988 and December 2015 were collected retrospectively. Thirty-two patients survived and remained for follow-up after the primary hospital stay until December 31, 2016. About 56.3% of discharged patients were alive at the end of follow-up. In 81.3% of discharged patients, need for renal replacement therapy subsided before discharge. Two patients received renal replacement therapy for longer than 3 months; however, need for renal replacement therapy subsided in both patients. One patient required dialysis several years later on after the need for renal replacement therapy had subsided. This study showed that long-term need for renal replacement therapy is rare after severe burn injury. In the vast majority of patients, need for renal replacement therapy subsided before discharge from primary care. Acute kidney injury in association with burns is a potential but small risk factor for later worsening of kidney function in fragile individuals.

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

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0602 ◽

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 >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 < 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.

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Coupled-plasma filtration and adsorption for severe burn patients with septic shock and acute kidney injury treated with renal replacement therapy

Burns ◽

10.1016/j.burns.2019.05.017 ◽

2020 ◽

Vol 46 (1) ◽

pp. 190-198 ◽

Cited By ~ 1

Author(s):

Filippo Mariano ◽

Zsuzsanna Hollo’ ◽

Nadia Depetris ◽

Valeria Malvasio ◽

Alberto Mella ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Burn Patients ◽

Severe Burn ◽

Plasma Filtration

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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

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw413 ◽

2017 ◽

Vol 32 (1) ◽

pp. 81-88 ◽

Cited By ~ 1

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.

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Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a randomized controlled multicenter crossover trial

10.21203/rs.3.rs-21846/v1 ◽

2020 ◽

Author(s):

Fang Liu ◽

Jing Zhang ◽

Yuan Zhu ◽

Lianjiu Su ◽

Yiming Li ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Intravenous Infusion ◽

Crossover Trial ◽

Kidney Injury ◽

Hospital Death ◽

Ringer’S Solution

Abstract Background: The previous study demonstrated that there were no significant differences between saline and balanced crystalloid solution infused in critical illness. However, the sepsis subgroup analysis showed the statistical difference. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on acute kidney injury (AKI) are related to the underline AKI severity and total volumes of infusion. Methods/design: The investigators designed a pragmatic, multi-centered crossover trial recruiting 312 patients who are diagnosed as sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer's solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrollment are excluded. Enrolled patients will be regarded as with mild, moderate or severe sepsis on the basis of the severity of their illness, and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events (MAKE), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28 days-mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT and ICU and hospital length of stay. Results and Conclusions: To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration. Trial registration: ClinicalTrials.gov, identifiers: NCT03685214. Registered on August 15, 2018. https://clinicaltrials.gov/ct2/show/NCT03685214 Keywords: sepsis; septic shock; acute kidney injury; saline; acetate Ringer's solution.

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Efficacy of Three Renal Replacement Therapy Modalities for the Treatment of Acute Kidney Injury Caused by Wasp Sting

Blood Purification ◽

10.1159/000514284 ◽

2021 ◽

pp. 1-11

Author(s):

Fugang Li ◽

Li Liu ◽

Dezheng Chen ◽

Yong Zhang ◽

Mingli Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Therapeutic Effects ◽

Wasp Sting ◽

Laboratory Results ◽

Better Than

Background/Aim: This study mainly aimed to explore the therapeutic effects of 3 renal replacement therapy (RRT) modalities on acute kidney injury (AKI) caused by wasp stings. Methods: A retrospective study from September 2016 to December 2019 was conducted. Thirty-one patients with AKIs caused by wasp sting were selected and divided into 3 groups according to the initial RRT modality received, namely, (1) the intermittent hemodialysis combined with hemoperfusion (IHD + HP) group, (2) the continuous veno-venous hemodiafiltration (CVVHDF) group, and (3) the CVVHDF combined with HP (CVVHDF + HP) group. The laboratory results were measured and analyzed before treatment on the 3rd, 7th, and 14th days of treatment. The renal function outcomes and survival of the patients were investigated at 3 months follow-up. Results: The laboratory results of enzyme measures and inflammatory indicators in wasp sting patients increased significantly in the early stage and 3 RRT modalities were effective in reducing these indicators. In addition, continuous RRT modality (CVVHDF and CVVHDF + HP) showed better clearance of myoglobin than IHD + HP. The serum creatinine levels of patients in the 3 groups did not recover to baseline within 14 days after beginning treatment. Nevertheless, the CVVHDF + HP group was better than the CVVHDF group, and CVVHDF was better than the IHD + HP group on the 3rd day. The interleukin (IL)-6 and IL-10 levels in CVVHDF + HP and IHD + HP groups were obviously lower than those in the CVVHDF group on the 3rd day. In the follow-up study, the recovery rate of renal function in CVVHDF and CVVHDF + HP groups was significantly better than that in the IHD + HP group. Conclusion: Early RRT was effective in the treatment of patients with A KI caused by wasp sting. CVVHDF + HP and CVVHDF modalities were better than the IHD + HP group in venom clearance and renal function recovery.

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Hematuria Is Associated with More Severe Acute Tubulointerstitial Nephritis

Journal of Clinical Medicine ◽

10.3390/jcm9072135 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2135

Author(s):

Raquel Esteras ◽

Jonathan G. Fox ◽

Colin C. Geddes ◽

Bruce Mackinnon ◽

Alberto Ortiz ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Tubulointerstitial Nephritis ◽

Kidney Injury ◽

Common Cause ◽

Acute Tubulointerstitial Nephritis ◽

Acute Dialysis

Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury. Although haematuria is a risk factor for the development of renal disease, no previous study has analyzed the significance of haematuria in ATIN. Retrospective, observational analysis of 110 patients with biopsy-proven ATIN was conducted. Results: Haematuria was present in 66 (60%) ATIN patients. A higher percentage of ATIN patients with haematuria had proteinuria than patients without haematuria (89.4% vs. 59.1%, p = 0.001) with significantly higher levels of proteinuria (median (interquartile range) protein:creatinine ratio 902.70 (513–1492) vs. 341.00 (177–734) mg/g, p <0.001). Moreover, those patients with more haematuria intensity had a higher urinary protein:creatinine ratio (1352.65 (665–2292) vs. 849.60 (562–1155) mg/g, p = 0.02). Those patients with higher proteinuria were more likely to need renal replacement therapy (22.7 vs. 0%, p = 0.03) and to suffer relapse (4 vs. 0%, p = 0.03). At the end of follow up, haematuric ATIN patients had higher serum creatinine levels (3.19 ± 2.91 vs. 1.91 ± 1.17 mg/dL, p = 0.007), and a trend towards a higher need for acute dialysis (7 vs. 1%, p = 0.09) and renal replacement therapy (12.1 vs. 2.3%, p = 0.12). Haematuria is common in ATIN and it is associated with worse renal function outcomes.

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MO160COVID-19 INFECTION AND ACUTE TUBULOINTERSTITIAL NEPHRITIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0038 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Juan Carlos León ◽

Irene Agraz ◽

Ander Vergara Arana ◽

Natalia Ramos Terrada ◽

Clara García Carro ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Kidney Function ◽

Nosocomial Pneumonia ◽

Tubulointerstitial Nephritis ◽

Kidney Injury ◽

Acute Tubulointerstitial Nephritis ◽

History Of

Abstract Background COVID-19 infection manifests as pneumonia associated with multiple organ failure, and death. Acute kidney injury is a risk factor for mortality. There is limited scientific literature on COVID-19 infection and allergic tubulointerstitial nephritis, its clinical course and short- and long-term prognosis. Method We performed a retrospective study where medical records of 60 patients with histological diagnosis of allergic tubulointerstitial nephritis from January 2009 to November 2020. In these patients, we studied the incidence of COVID-19 infection, clinical characteristics and prognosis from March to the actual date. Results Of 60 patients with allergic tubulointerstitial nephritis, 6 (10%) patients were diagnosed with COVID-19. The first case, an 85-year-old woman with a history of metastatic melanoma treated with nivolumab and allergic tubulointerstitial nephritis by immunobiological agents in 2018, diagnosed with mild COVID-19 infection in April 2020 without deterioration of renal function in controls at 3 and 6 months of follow-up. The second case, a 51-year-old woman with a history of large B-cell lymphoma with plasmacytic differentiation and progression to multiple myeloma of lambda light chains and allergic tubulointerstitial nephritis due to chemotherapy since 2019, admitted for acute pyelonephritis and PRES syndrome secondary to first dose of bortezomib complicated with COVID-19 nosocomial pneumonia and acute pancreatitis treated with corticosteroids and broad spectrum antibiotic therapy; she died of abdominal refractory septic shock. The third patient, a 64-year-old man without prior renal impairment, was admitted for severe COVID-19 pneumonia and acute kidney injury secondary to acute tubulointerstitial nephritis of uncertain etiology that required orotracheal intubation and continuous veno-venous hemodiafiltration for a week who received methylprednisolone in bolus for 3 days and continued treatment with corticosteroid therapy with complete recovery of renal function and improvement in proteinuria at 3 months of follow-up. The fourth patient, an 82-year-old woman with acute kidney injury AKIN 3 secondary to acute allergic tubulointerstitial nephritis related to ciprofloxacin complicated with severe COVID-19 nosocomial pneumonia, who died despite ventilatory support and high-dose steroids therapy and tocilizumab. The fifth patient, a 75-year-old with a history of metastatic lung adenocarcinoma treated with immunobiological agents and allergic tubulointerstitial nephritis in 2018, admitted in march 2020 for mild COVID-19 pneumonia treated with steroids and hydroxychloroquine without deterioration of respiratory and kidney function. The sixth patient, an 86-years-old man with acute kidney injury AKIN 3 due to acute allergic tubulointerstitial nephritis secondary to proton-binding inhibitors and nosocomial COVID-19 infección with improvement of kidney function with steroids therapy only. Conclusion Our 6 patients with allergic tubulointerstitial nephritis and COVID-19 infection presented different spectrum of the disease. It seems that nosocomial COVID-19 infection in patients admitted with recent diagnosis of acute allergic tubulointerstitial nephritis presented a worse clinical prognosis compared with long-term diagnosed acute tubulointerstitial nephritis. Further studies with a larger sample size are needed.

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

Clinical Kidney Journal ◽

10.1093/ckj/sfaa130 ◽

2020 ◽

Cited By ~ 1

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.

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