Predictors of health utility among 60-day survivors of acute kidney injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study.
OBJECTIVE
Health-related quality of life (HRQOL) after acute kidney injury (AKI) is an area of great importance to patients. It was hypothesized that HRQOL after AKI would relate to intensity of dialysis during AKI and dialysis dependence at follow-up.


METHODS
The Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study was a multicenter, prospective, randomized trial of intensive versus less intensive renal replacement therapy in critically ill patients with AKI. Of 1124 participants, 415 survived at least 60 days and completed the Health Utilities Index (HUI), which measures 8 health attributes and calculates an overall HRQOL score, also called a utility score. How strongly pre-intensive care unit (ICU) health, severity of illness, hospital course, intensity of dialysis, and outcome were associated with 60-day HUI scores was assessed, after adjustment for demographics.


RESULTS
The overall HUI score was 0.40 +/- 0.37, indicating severely compromised health utility and was associated with only admission from home and hospital and ICU length of stay (LOS). Ambulation was better among those with a shorter hospital and ICU LOS. Better cognition was associated with dialysis independence and with fewer comorbid chronic illnesses. Emotion was associated with only hospital LOS. Pain was associated with ICU LOS.


CONCLUSIONS
Health utility was low in this cohort of patients after AKI, and intensity of dialysis did not affect subsequent health utility. The effects of a lengthy hospitalization generally outweighed the effects of delayed recovery of kidney function on HRQOL after AKI.
San Francisco VA Medical Center and University of California, San Francisco, San Francisco, California 94121, USA. kirsten.johansen@ucsf.edu
Kirsten L
KL
Johansen
Mark W
MW
Smith
Mark L
ML
Unruh
Andrew M
AM
Siroka
Theresa Z
TZ
O'Connor
Paul M
PM
Palevsky
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003071:Cognition; D015897:Comorbidity; D016638:Critical Illness; D004185:Disability Evaluation; D004644:Emotions; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D010146:Pain / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate; D017741:Survivors / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D016138:Walking