title: Six-month survival and quality of life of intensive care patients with acute kidney injury.
abstract: BACKGROUND
  Acute kidney injury (AKI) has high incidence among the critically ill and associates with dismal outcome. Not only the long-term survival, but also the quality of life (QOL) of patients with AKI is relevant due to substantial burden of care regarding these patients. We aimed to study the long-term outcome and QOL of patients with AKI treated in intensive care units.
  
  
  METHODS
  We conducted a predefined six-month follow-up of adult intensive care unit (ICU) patients from the prospective, observational, multi-centre FINNAKI study. We evaluated the QOL of survivors with the EuroQol (EQ-5D) questionnaire. We included all participating sites with at least 70% rate of QOL measurements in the analysis.
  
  
  RESULTS
  Of the 1,568 study patients, 635 (40.5%, 95% confidence interval (CI) 38.0-43.0%) had AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of the 635 AKI patients, 224 (35.3%), as compared to 154/933 (16.5%) patients without AKI, died within six months. Of the 1,190 survivors, 959 (80.6%) answered the EQ-5D questionnaire at six months. The QOL (median with Interquartile range, IQR) measured with the EQ-5D index and compared to age- and sex-matched general population was: 0.676 (0.520-1.00) versus 0.826 (0.812-0.859) for AKI patients, and 0.690 (0.533-1.00) versus 0.845 (0.812-0.882) for patients without AKI (P <0.001 in both). The EQ-5D at the time of ICU admission was available for 774 (80.7%) of the six-month respondents. We detected a mean increase of 0.017 for non-AKI and of 0.024 for AKI patients in the EQ-5D index (P = 0.728). The EQ-5D visual analogue scores (median with IQR) of patients with AKI (70 (50-83)) and patients without AKI (75 (60-87)) were not different from the age- and sex-matched general population (69 (68-73) and 70 (68-77)).
  
  
  CONCLUSIONS
  The health-related quality of life of patients with and without AKI was already lower on ICU admission than that of the age- and sex-matched general population, and did not change significantly during critical illness. Patients with and without AKI rate their subjective health to be as good as age and sex-matched general population despite statistically significantly lower QOL indexes measured by EQ-5D.
authors.forename: Sara
authors.initials: S
authors.lastname: Nisula
authors.forename: Suvi T
authors.initials: ST
authors.lastname: Vaara
authors.forename: Kirsi-Maija
authors.initials: KM
authors.lastname: Kaukonen
authors.forename: Matti
authors.initials: M
authors.lastname: Reinikainen
authors.forename: Simo-Pekka
authors.initials: SP
authors.lastname: Koivisto
authors.forename: Outi
authors.initials: O
authors.lastname: Inkinen
authors.forename: Meri
authors.initials: M
authors.lastname: Poukkanen
authors.forename: Pekka
authors.initials: P
authors.lastname: Tiainen
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Korhonen
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000628:therapy*; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D003422:Critical Care; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers