Recovery after AKI: Effects on outcomes over 15 years

Sadudee Peerapornratana; Marco Fiorentino; Priyanka Priyanka; Raghavan Murugan; John A Kellum

doi:10.1016/j.jcrc.2023.154280

Recovery after AKI: Effects on outcomes over 15 years

J Crit Care. 2023 Aug:76:154280. doi: 10.1016/j.jcrc.2023.154280. Epub 2023 Feb 26.

Authors

Sadudee Peerapornratana¹, Marco Fiorentino², Priyanka Priyanka³, Raghavan Murugan³, John A Kellum⁴

Affiliations

¹ The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Excellence Center for Critical Care Nephrology, Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
² The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy.
³ The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
⁴ The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; The CRISMA (Clinical Research, Investigation and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America. Electronic address: kellum@pitt.edu.

PMID: 36848723
PMCID: PMC10238673 (available on 2024-08-01)
DOI: 10.1016/j.jcrc.2023.154280

Abstract

Purpose: To examine the effect of kidney recovery on mortality, dialysis and kidney transplantation up to 15 years after AKI.

Materials and methods: We studied 29,726 survivors of critical illness and compared these outcomes stratified by AKI and recovery status at hospital discharge. Kidney recovery was defined as a return of serum creatinine to ≤150% of baseline without dialysis prior to hospital discharge.

Results: Overall AKI occurred in 59.2% in which two thirds developed stage 2-3 AKI. Recovery rate of AKI at hospital discharge was 80.8%. Patients who did not recover experienced the worst 15-year mortality compared to those who recovered and those without AKI (57.8% vs 45.2% vs 30.3%, p < 0.001). This pattern was also found in subgroups of patients with suspected sepsis-associated (57.1% vs 47.9% vs 36.5%, p < 0.001) and cardiac surgery-associated AKI (60.1% vs 41.8% vs 25.9%, p < 0.001). The rates of dialysis and transplantation at 15 years were low and not associated with recovery status.

Conclusions: Recovery of AKI in critically ill patients at hospital discharge had an effect on long-term mortality for up to 15 years. These results have implications for acute care, follow-up and choice of endpoints for clinical trials.

Keywords: Critically ill; Outcomes; Recovery; Renal failure; Transplantation; dialysis.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Acute Kidney Injury* / therapy
Critical Care
Humans
Patient Discharge
Renal Dialysis
Retrospective Studies
Risk Factors
Sepsis*

Abstract

Publication types

MeSH terms

Grants and funding