Advanced

Small Acute Increases in Serum Creatinine Are Associated with Decreased Long-Term Survival in the Critically Ill

Linder, Adam LU ; Fjell, Chris; Levin, Adeera; Walley, Keith R.; Russell, James A. and Boyd, John H. (2014) In American Journal of Respiratory and Critical Care Medicine 189(9). p.1075-1081
Abstract
Rationale: Long-term outcomes after acute kidney injury (AKI) are poorly described. Objectives: We hypothesized that one single episode of minimal (stage 1) AKI is associated with reduced long-term survival compared with no AKI after recovery from critical illness. Methods: A prospective cohort of 2,010 intensive care unit (ICU) patients admitted to the ICU between years 2000 and 2009 at a provincial tertiary care hospital. Development of AKI was determined according to the KDIGO classification and mortality up to 10 years after ICU admission was recorded. Measurements and Main Results: Of the 1,844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had no AKI. The 28-day, 1-year, 5-year, and 10-year... (More)
Rationale: Long-term outcomes after acute kidney injury (AKI) are poorly described. Objectives: We hypothesized that one single episode of minimal (stage 1) AKI is associated with reduced long-term survival compared with no AKI after recovery from critical illness. Methods: A prospective cohort of 2,010 intensive care unit (ICU) patients admitted to the ICU between years 2000 and 2009 at a provincial tertiary care hospital. Development of AKI was determined according to the KDIGO classification and mortality up to 10 years after ICU admission was recorded. Measurements and Main Results: Of the 1,844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had no AKI. The 28-day, 1-year, 5-year, and 10-year survival rates were 67.1%, 51.8%, 44.1%, and 36.3% in patients with mild AKI, which was significantly worse compared with the critically ill patients with no AKI at any time (P < 0.01). The unadjusted 10-year mortality hazard ratio was 1.53 (95% confidence interval, 1.2-2.0) for 28-day survivors with stage 1 AKE compared with critically ill patients with no AKI. Adjusted 10-year mortality risk was 1.26 (1.0-1.6). After propensity matching stage 1 AKI with no AKE patients, mild AKE was still significantly associated with decreased 10-year survival (P =0.036). Conclusions: Patients with one episode of mild AKI have significantly lower long-term survival rates than critically ill patients with no AKI. Close medical follow-up of these patients may be warranted and mechanistic research is required to understand how AKI influences long-term events. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute kidney injury, long-term survival, critical illness
in
American Journal of Respiratory and Critical Care Medicine
volume
189
issue
9
pages
1075 - 1081
publisher
Am Thoracic Soc
external identifiers
  • wos:000335366500012
  • scopus:84899832419
ISSN
1535-4970
DOI
10.1164/rccm.201311-2097OC
language
English
LU publication?
yes
id
d2802b1a-b6d0-48fc-b50b-50e82f78f882 (old id 4482352)
date added to LUP
2014-07-01 07:36:27
date last changed
2017-11-05 03:04:54
@article{d2802b1a-b6d0-48fc-b50b-50e82f78f882,
  abstract     = {Rationale: Long-term outcomes after acute kidney injury (AKI) are poorly described. Objectives: We hypothesized that one single episode of minimal (stage 1) AKI is associated with reduced long-term survival compared with no AKI after recovery from critical illness. Methods: A prospective cohort of 2,010 intensive care unit (ICU) patients admitted to the ICU between years 2000 and 2009 at a provincial tertiary care hospital. Development of AKI was determined according to the KDIGO classification and mortality up to 10 years after ICU admission was recorded. Measurements and Main Results: Of the 1,844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had no AKI. The 28-day, 1-year, 5-year, and 10-year survival rates were 67.1%, 51.8%, 44.1%, and 36.3% in patients with mild AKI, which was significantly worse compared with the critically ill patients with no AKI at any time (P &lt; 0.01). The unadjusted 10-year mortality hazard ratio was 1.53 (95% confidence interval, 1.2-2.0) for 28-day survivors with stage 1 AKE compared with critically ill patients with no AKI. Adjusted 10-year mortality risk was 1.26 (1.0-1.6). After propensity matching stage 1 AKI with no AKE patients, mild AKE was still significantly associated with decreased 10-year survival (P =0.036). Conclusions: Patients with one episode of mild AKI have significantly lower long-term survival rates than critically ill patients with no AKI. Close medical follow-up of these patients may be warranted and mechanistic research is required to understand how AKI influences long-term events.},
  author       = {Linder, Adam and Fjell, Chris and Levin, Adeera and Walley, Keith R. and Russell, James A. and Boyd, John H.},
  issn         = {1535-4970},
  keyword      = {acute kidney injury,long-term survival,critical illness},
  language     = {eng},
  number       = {9},
  pages        = {1075--1081},
  publisher    = {Am Thoracic Soc},
  series       = {American Journal of Respiratory and Critical Care Medicine},
  title        = {Small Acute Increases in Serum Creatinine Are Associated with Decreased Long-Term Survival in the Critically Ill},
  url          = {http://dx.doi.org/10.1164/rccm.201311-2097OC},
  volume       = {189},
  year         = {2014},
}