Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study
In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse ki...
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description | In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT.
We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital. During the study period from August 2004 through December 2012, all consecutive adult patients with AKI-RRT were included. Data were prospectively recorded during the patients' hospital stay and were retrieved from the hospital databases. Data on long-term follow-up were gathered during follow-up consultation or, in the absence of this, by consulting the general physician.
AKI-RRT was reported in 1292 of 23,665 first ICU admissions (5.5 %). Mortality increased from 59.7 % at hospital discharge to 72.1 % at 3 years. A Cox proportional hazards model demonstrated an association of increasing age, severity of illness, and continuous RRT with long-term mortality. Among hospital survivors with reference creatinine measurements, 1-year renal recovery was complete in 48.4 % and incomplete in 32.6 %. Dialysis dependence was reported in 19.0 % and was associated with age, diabetes, chronic kidney disease (CKD), and oliguria at the time of initiation of RRT. MAKE increased from 83.1 % at hospital discharge to 93.7 % at 3 years. Multivariate regression analysis showed no association of classical determinants of outcome (preexisting CKD, timing of initiation of RRT, and RRT modality) with MAKE at 1 year.
Our study demonstrates poor long-term survival after AKI-RRT that was determined mainly by severity of illness and RRT modality at initiation of RRT. Renal recovery is limited, especially in patients with acute-on-chronic kidney disease, making nephrological follow-up imperative. MAKE is associated mainly with variables determining mortality. |
doi_str_mv | 10.1186/s13054-016-1409-z |
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We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital. During the study period from August 2004 through December 2012, all consecutive adult patients with AKI-RRT were included. Data were prospectively recorded during the patients' hospital stay and were retrieved from the hospital databases. Data on long-term follow-up were gathered during follow-up consultation or, in the absence of this, by consulting the general physician.
AKI-RRT was reported in 1292 of 23,665 first ICU admissions (5.5 %). Mortality increased from 59.7 % at hospital discharge to 72.1 % at 3 years. A Cox proportional hazards model demonstrated an association of increasing age, severity of illness, and continuous RRT with long-term mortality. Among hospital survivors with reference creatinine measurements, 1-year renal recovery was complete in 48.4 % and incomplete in 32.6 %. Dialysis dependence was reported in 19.0 % and was associated with age, diabetes, chronic kidney disease (CKD), and oliguria at the time of initiation of RRT. MAKE increased from 83.1 % at hospital discharge to 93.7 % at 3 years. Multivariate regression analysis showed no association of classical determinants of outcome (preexisting CKD, timing of initiation of RRT, and RRT modality) with MAKE at 1 year.
Our study demonstrates poor long-term survival after AKI-RRT that was determined mainly by severity of illness and RRT modality at initiation of RRT. Renal recovery is limited, especially in patients with acute-on-chronic kidney disease, making nephrological follow-up imperative. MAKE is associated mainly with variables determining mortality.</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>DOI: 10.1186/s13054-016-1409-z</identifier><identifier>PMID: 27520553</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Care and treatment ; Chronic kidney failure ; Health aspects ; Intensive care units ; Patient outcomes ; Services</subject><ispartof>Critical care (London, England), 2016-08, Vol.20 (1), p.256-256, Article 256</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>The Author(s). 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-cb77bbc90bba2dfd304786b48a7fc322d76780cb927315137c1beba6584f8e0f3</citedby><cites>FETCH-LOGICAL-c427t-cb77bbc90bba2dfd304786b48a7fc322d76780cb927315137c1beba6584f8e0f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983760/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983760/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27520553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De Corte, Wouter</creatorcontrib><creatorcontrib>Dhondt, Annemieke</creatorcontrib><creatorcontrib>Vanholder, Raymond</creatorcontrib><creatorcontrib>De Waele, Jan</creatorcontrib><creatorcontrib>Decruyenaere, Johan</creatorcontrib><creatorcontrib>Sergoyne, Veerle</creatorcontrib><creatorcontrib>Vanhalst, Joke</creatorcontrib><creatorcontrib>Claus, Stefaan</creatorcontrib><creatorcontrib>Hoste, Eric A J</creatorcontrib><title>Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study</title><title>Critical care (London, England)</title><addtitle>Crit Care</addtitle><description>In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT.
We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital. During the study period from August 2004 through December 2012, all consecutive adult patients with AKI-RRT were included. Data were prospectively recorded during the patients' hospital stay and were retrieved from the hospital databases. Data on long-term follow-up were gathered during follow-up consultation or, in the absence of this, by consulting the general physician.
AKI-RRT was reported in 1292 of 23,665 first ICU admissions (5.5 %). Mortality increased from 59.7 % at hospital discharge to 72.1 % at 3 years. A Cox proportional hazards model demonstrated an association of increasing age, severity of illness, and continuous RRT with long-term mortality. Among hospital survivors with reference creatinine measurements, 1-year renal recovery was complete in 48.4 % and incomplete in 32.6 %. Dialysis dependence was reported in 19.0 % and was associated with age, diabetes, chronic kidney disease (CKD), and oliguria at the time of initiation of RRT. MAKE increased from 83.1 % at hospital discharge to 93.7 % at 3 years. Multivariate regression analysis showed no association of classical determinants of outcome (preexisting CKD, timing of initiation of RRT, and RRT modality) with MAKE at 1 year.
Our study demonstrates poor long-term survival after AKI-RRT that was determined mainly by severity of illness and RRT modality at initiation of RRT. Renal recovery is limited, especially in patients with acute-on-chronic kidney disease, making nephrological follow-up imperative. MAKE is associated mainly with variables determining mortality.</description><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>Health aspects</subject><subject>Intensive care units</subject><subject>Patient outcomes</subject><subject>Services</subject><issn>1364-8535</issn><issn>1466-609X</issn><issn>1364-8535</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNpVkU-L1TAUxYMozszTD-BGAm7cVPOvSepCGB6ODjxw44C7kKa373Vsm5qkIx3wu5vScdBNbuD-zuHeexB6Rck7SrV8HyknpSgIlQUVpCrun6BzKqQsJKm-P81_LkWhS16eoYsYbwmhSkv-HJ0xVTJSlvwc_T748VgkCAP2c3J-ANyN-Hp_gyebOhhTxL-6dMLWzQnwj64ZYcnE7RwWnALYBM0GBBhtn9-ptw6GLMTpBMFOywds8RR8nMCl7g6w8ycfEo5pbpYX6Flr-wgvH-oO3Vx9-rb_Uhy-fr7eXx4KJ5hKhauVqmtXkbq2rGkbTkRepBbaqtZxxhollSaurpjitKRcOVpDbWWpRauBtHyHPm6-01wP0Lg8XrC9mUI32LAYbzvzf2fsTubo74yoNFeSZIO3DwbB_5whJjN00UHf2xH8HA3VlAnBGFvRNxt6tD2Ybmx9dnQrbi6F1JrK1XSH6Ea5fJoYoH0chhKzhmu2cE0O16zhmvusef3vFo-Kv2nyP8ogozk</recordid><startdate>20160812</startdate><enddate>20160812</enddate><creator>De Corte, Wouter</creator><creator>Dhondt, Annemieke</creator><creator>Vanholder, Raymond</creator><creator>De Waele, Jan</creator><creator>Decruyenaere, Johan</creator><creator>Sergoyne, Veerle</creator><creator>Vanhalst, Joke</creator><creator>Claus, Stefaan</creator><creator>Hoste, Eric A J</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160812</creationdate><title>Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study</title><author>De Corte, Wouter ; Dhondt, Annemieke ; Vanholder, Raymond ; De Waele, Jan ; Decruyenaere, Johan ; Sergoyne, Veerle ; Vanhalst, Joke ; Claus, Stefaan ; Hoste, Eric A J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-cb77bbc90bba2dfd304786b48a7fc322d76780cb927315137c1beba6584f8e0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Care and treatment</topic><topic>Chronic kidney failure</topic><topic>Health aspects</topic><topic>Intensive care units</topic><topic>Patient outcomes</topic><topic>Services</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>De Corte, Wouter</creatorcontrib><creatorcontrib>Dhondt, Annemieke</creatorcontrib><creatorcontrib>Vanholder, Raymond</creatorcontrib><creatorcontrib>De Waele, Jan</creatorcontrib><creatorcontrib>Decruyenaere, Johan</creatorcontrib><creatorcontrib>Sergoyne, Veerle</creatorcontrib><creatorcontrib>Vanhalst, Joke</creatorcontrib><creatorcontrib>Claus, Stefaan</creatorcontrib><creatorcontrib>Hoste, Eric A J</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>De Corte, Wouter</au><au>Dhondt, Annemieke</au><au>Vanholder, Raymond</au><au>De Waele, Jan</au><au>Decruyenaere, Johan</au><au>Sergoyne, Veerle</au><au>Vanhalst, Joke</au><au>Claus, Stefaan</au><au>Hoste, Eric A J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study</atitle><jtitle>Critical care (London, England)</jtitle><addtitle>Crit Care</addtitle><date>2016-08-12</date><risdate>2016</risdate><volume>20</volume><issue>1</issue><spage>256</spage><epage>256</epage><pages>256-256</pages><artnum>256</artnum><issn>1364-8535</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><abstract>In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT.
We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital. During the study period from August 2004 through December 2012, all consecutive adult patients with AKI-RRT were included. Data were prospectively recorded during the patients' hospital stay and were retrieved from the hospital databases. Data on long-term follow-up were gathered during follow-up consultation or, in the absence of this, by consulting the general physician.
AKI-RRT was reported in 1292 of 23,665 first ICU admissions (5.5 %). Mortality increased from 59.7 % at hospital discharge to 72.1 % at 3 years. A Cox proportional hazards model demonstrated an association of increasing age, severity of illness, and continuous RRT with long-term mortality. Among hospital survivors with reference creatinine measurements, 1-year renal recovery was complete in 48.4 % and incomplete in 32.6 %. Dialysis dependence was reported in 19.0 % and was associated with age, diabetes, chronic kidney disease (CKD), and oliguria at the time of initiation of RRT. MAKE increased from 83.1 % at hospital discharge to 93.7 % at 3 years. Multivariate regression analysis showed no association of classical determinants of outcome (preexisting CKD, timing of initiation of RRT, and RRT modality) with MAKE at 1 year.
Our study demonstrates poor long-term survival after AKI-RRT that was determined mainly by severity of illness and RRT modality at initiation of RRT. Renal recovery is limited, especially in patients with acute-on-chronic kidney disease, making nephrological follow-up imperative. MAKE is associated mainly with variables determining mortality.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27520553</pmid><doi>10.1186/s13054-016-1409-z</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Care and treatment Chronic kidney failure Health aspects Intensive care units Patient outcomes Services |
title | Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study |
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