title: Impact of non-dialysis chronic kidney disease on survival in patients with septic shock.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is known to expose the patient to a high risk of death due to cardiovascular and infective causes. In parallel, septic shock is a major challenge for cardiovascular and immune system. Therefore we tried to determine whether non-dialysis CKD, defined as a baseline estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, for three months prior to the onset of septic shock is an independent risk factor for death.
  
  
  METHODS
  All patients treated in a teaching hospital medical ICU for septic shock between January 2007 and December 2009 were retrospectively analyzed. Patients in whom baseline eGFR could not be determined (n=14) or patients treated by chronic dialysis (n=21) or kidney transplantation (n=14) were excluded. A total of 163 patients were included. The population was divided according to baseline eGFR ≥ 60 ml/min/1.73 m2 (non-CKD group, n=107) and < 60 ml/min/1.73 m2 (CKD group, n=56). Twenty-eight-day and 1-year survival curves were plotted. Prognostic factors were determined using Cox proportional hazards models.
  
  
  RESULTS
  Baseline eGFR was significantly higher in the non-CKD group than in the CKD group (81 (67-108) vs. 36 (28-44) ml/min/1.73 m2, respectively; p=0.001). Age, SAPS II, serum creatinine on admission and the number of patients with a history of diabetes, hypertension, heart failure, peripheral artery disease, coronary artery disease and statin medication were significantly higher in the CKD group than in the non-CKD group. The mortality rate was lower in the non-CKD group than in the CKD group after 28 days (50% vs. 70%, respectively; p=0.03) and 1 year (64% vs. 82%, respectively; p=0.03). On multivariate analysis, the dichotomous variable CKD (eGFR < 60 ml/min/1.73 m2) remained significantly associated with the 28-day and 1-year mortality.
  
  
  CONCLUSIONS
  Non-dialysis CKD appears to be an independent risk factor for death after septic shock.
authors.affiliation: Medical Intensive Care Unit, Department of Nephrology, Amiens University Medical Center, Amiens, France and INSERM U-1088, Jules Verne University of Picardie, Amiens, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Maizel
authors.forename: Romain
authors.initials: R
authors.lastname: Deransy
authors.forename: Benedicte
authors.initials: B
authors.lastname: Dehedin
authors.forename: Edouard
authors.initials: E
authors.lastname: Secq
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lewandowski
authors.forename: Chritstophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.forename: Gabriel
authors.initials: G
authors.lastname: Choukroun
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000401:mortality*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends
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