Long-term prognosis after acute kidney injury requiring renal replacement therapy.
BACKGROUND
Data on the long-term survival and renal function of patients with acute kidney injury (AKI) treated with continuous renal replacement therapy are scarce.


METHODS
We investigated the 3-year survival and need for chronic dialysis in critically ill patients, who had survived an episode of AKI requiring continuous renal replacement therapy.


RESULTS
A total of 206 ICU patients with AKI were randomized in a trial comparing haemofiltration versus haemodiafiltration. Of these, 95 (46%) survived at 90 days. Post-discharge information relating to 3-year survival and renal function was successfully obtained in 89 (94%) of the patients. Of the 89 patients studied, chronic kidney disease (CKD) was present in 32 subjects from the onset, and CKD developed de novo in 25 patients following AKI. End-stage renal disease (ESRD) developed in 9 patients (of whom 8 had pre-existing CKD) and 29 patients died. Three-year survival was 67% overall; the mortality at 3 years was 50% for those with pre-existing kidney disease, and 71 and 82% for those with de novo and without CKD, respectively.


CONCLUSIONS
After an episode of AKI necessitating a continuous renal replacement therapy, rapid progression to ESKD is commonly observed in patients with pre-existing chronic renal impairment. Medical care with an emphasis on nephroprotection is necessary in these patients.
Triverio
Pierre-Alain
PA
Service de Néphrologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Martin
Pierre-Yves
PY
Romand
Jacques
J
Pugin
Jerome
J
Perneger
Thomas
T
Saudan
Patrick
P
D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy; D015996:Survival Rate; D013997:Time Factors