Kidney function decline after a non-dialysis-requiring acute kidney injury is associated with higher long-term mortality in critically ill survivors.
BACKGROUND
The adverse consequences of a non-dialysis-requiring acute kidney injury (AKI) are unclear. This study aimed to assess the long-term prognoses for critically ill patients experiencing a non-dialysis-requiring AKI.


METHODS
This retrospective observational cohort study investigated non-dialysis-requiring AKI survivors in surgical intensive care units between January 2002 and June 2010. All longitudinal post-discharge serum creatinine measurements and information regarding end-stage renal disease (ESRD) and death were collected. We assessed the long-term outcomes of chronic kidney disease (CKD), ESRD and all-cause mortality beyond discharge.


RESULTS
Of the 922 identified critically ill patients with a non-dialysis-requiring AKI, 634 (68.8%) patients who survived to discharge were enrolled. A total of 207 patients died after a median follow-up of 700.5 days. The median intervals between the onset of the AKI and the composite endpoints "stage 3 CKD or death", "stage 4 CKD or death", "stage 5 CKD or death", and "ESRD or death" were 685, 1319, 1743, and 2048 days, respectively. This finding shows a steady long-term decline in kidney function after discharge. Using the multivariate Cox proportional hazard model, we found that every 1 mL/min/1.73 m2 decrease from baseline estimated glomerular filtration rate (eGFR) of individuals who progressed to stage 3, 4, and 5 CKD increased the risks of long-term mortality by 0.7%, 2.3%, and 4.1%, respectively (all p < 0.05). This result indicates that the mortality risk increased significantly in a graded manner as kidney function declined from the baseline eGFR to advanced stages of CKD during the follow-up period.


CONCLUSIONS
In critically ill patients who survive a non-dialysis-requiring AKI, there is a need for continuous monitoring and kidney function protection beyond discharge.
Chun-Fu
CF
Lai
Vin-Cent
VC
Wu
Tao-Min
TM
Huang
Yu-Chang
YC
Yeh
Kuo-Chuan
KC
Wang
Yin-Yi
YY
Han
Yu-Feng
YF
Lin
Ying-Jheng
YJ
Jhuang
Chia-Ter
CT
Chao
Chih-Chung
CC
Shiao
Pi-Ru
PR
Tsai
Fu-Chang
FC
Hu
Nai-Kuan
NK
Chou
Wen-Je
WJ
Ko
Kwan-Dun
KD
Wu
D058186:Acute Kidney Injury / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D003404:Creatinine