title: Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Cardiac arrest patients often suffer from dysfunction of multiple organ systems after return of spontaneous circulation (ROSC). The incidence of renal dysfunction in patients with out-of-hospital cardiac arrest (OHCA) is not well described. Renal dysfunction has been associated with worse outcomes in critical illness.
  
  
  OBJECTIVE
  Renal dysfunction is common after OHCA, and renal dysfunction is independently associated with survival.
  
  
  METHODS
  We performed a retrospective review of consecutive adult patients admitted to an intensive care unit after successful resuscitation from OHCA between 01/01/2005 and 12/31/2010. Patients were excluded for death or withdrawal of care within 24h, preexisting end-stage renal disease, or OHCA due to hyperkalemia. The RIFLE criteria were used to classify subjects with renal dysfunction into one of three categories - risk, injury, or failure - based on trending of serum creatinine concentration or glomerular filtration rate. Data were analyzed using descriptive statistics.
  
  
  RESULTS
  Of 364 patients, 38 were excluded due to death or withdrawal of care within 24h, 11 due to end-stage renal disease, and 4 due to OHCA from hyperkalemia, leaving 311 patients in the final analysis. The mean age was 58 (SD 16) years; 174 (59%) were male, VF/VT was the primary rhythm in 156 (50%), and 236 (80%) were comatose at hospital arrival. Among 311 patients, 32 (10.3%) developed acute renal failure (ARF), 27 (8.7%) developed acute kidney injury (AKI), and 56 (18.0%) developed risk of renal dysfunction. Of the 32 subjects that developed ARF, renal replacement therapy (RRT) was initiated on 13 (40.6%). Development of ARF was not associated with survival (OR 0.73; 95% CI 0.26, 2.05) after adjusting for initial rhythm or illness severity.
  
  
  CONCLUSIONS
  More than one-third of patients resuscitated from OHCA developed evidence of renal dysfunction, and 19% of patients meeting criteria for AKI or ARF. In this study, development of renal failure was not independently associated with survival.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yanta
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.forename: Ankur A
authors.initials: AA
authors.lastname: Doshi
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012151:Resuscitation; D012189:Retrospective Studies
keywords: Cardiac arrest; Critical care; Hypothermia; Outcomes; Prognostication; Renal injury