Kidney function decline after a non-dialysis-requiring acute kidney injury is associated with higher long-term mortality in critically ill survivors
1 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan S Rd, Taipei 100, Taiwan
2 Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, 579 Sec 2, Yunlin Rd, Douliou City, Yunlin County 640, Taiwan
3 Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan S Rd, Taipei 100, Taiwan
4 Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan S Rd, Taipei 100, Taiwan
5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan S Rd., Taipei 100, Taiwan
6 Department of Internal Medicine, Saint Mary's Hospital, 160 Chung-Chen S Rd., Luodong, Yilan County 265, Taiwan
7 International Harvard Statistical Consulting Company, 7F-11, 57 Chongqing S Rd, Taipei 100, Taiwan
Critical Care 2012, 16:R123 doi:10.1186/cc11419
Please see related letter by Lopes and Jorge, http://ccforum.com/content/16/6/467Published: 12 July 2012
The adverse consequences of a non-dialysis-requiring acute kidney injury (AKI) are unclear. This study aimed to assess the long-term prognoses for critically ill patients experiencing a non-dialysis-requiring AKI.
This retrospective observational cohort study investigated non-dialysis-requiring AKI survivors in surgical intensive care units between January 2002 and June 2010. All longitudinal post-discharge serum creatinine measurements and information regarding end-stage renal disease (ESRD) and death were collected. We assessed the long-term outcomes of chronic kidney disease (CKD), ESRD and all-cause mortality beyond discharge.
Of the 922 identified critically ill patients with a non-dialysis-requiring AKI, 634 (68.8%) patients who survived to discharge were enrolled. A total of 207 patients died after a median follow-up of 700.5 days. The median intervals between the onset of the AKI and the composite endpoints "stage 3 CKD or death", "stage 4 CKD or death", "stage 5 CKD or death", and "ESRD or death" were 685, 1319, 1743, and 2048 days, respectively. This finding shows a steady long-term decline in kidney function after discharge. Using the multivariate Cox proportional hazard model, we found that every 1 mL/min/1.73 m2 decrease from baseline estimated glomerular filtration rate (eGFR) of individuals who progressed to stage 3, 4, and 5 CKD increased the risks of long-term mortality by 0.7%, 2.3%, and 4.1%, respectively (all p < 0.05). This result indicates that the mortality risk increased significantly in a graded manner as kidney function declined from the baseline eGFR to advanced stages of CKD during the follow-up period.
In critically ill patients who survive a non-dialysis-requiring AKI, there is a need for continuous monitoring and kidney function protection beyond discharge.