title: Impact of preexisting chronic kidney disease on acute and long-term outcome of critically ill patients on a medical intensive care unit.
abstract: BACKGROUND
  Chronic kidney disease (CKD) increases acute and long-term mortality of many diseases. Limited data are available, in how far a preexisting non-dialysis dependent CKD affects the outcome of critically ill patients treated for non-renal causes.
  
  
  METHODS
  In a retrospective study, we assessed the outcome of 524 patients with need for mechanical ventilation at our medical intensive care unit between 2002 and 2007. Patients were divided into 5 CKD stages depending on their calculated glomerular filtration rate at hospital admission excluding patients with pre-existing end-stage renal failure. In-hospital and long-term outcome up to 5 years were assessed.
  
  
  RESULTS
  Advanced stages of CKD at admission were associated with higher age (p < 0.001) and diabetes (p = 0.003). Patients with higher CKD stages suffered more often from acute renal failure (p < 0.001), required longer renal replacement therapy (p < 0.001) and more often in-hospital resuscitation (p = 0.019). 405 patients died during follow-up (226 in-hospital). Multivariate Cox regression analysis identified eGFR as independent predictor of 30-day- (HRR 0.994, 95 % CI 0.990-0.998) and 1-year-mortality (HRR 0.996, 95 % CI 0.993-1.000). Long-term survival decreased significantly with increasing CKD stages (p = 0.004) and occurrence of acute renal failure (p < 0.001).
  
  
  CONCLUSIONS
  In critically ill patients requiring mechanical ventilation, preexisting non-dialysis dependent CKD has marked impact on occurrence of acute renal failure, 30-day- and 1-year-mortality.
authors: Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Muenster, Münster, Germany.
authors: Pia
authors: P
authors: Lebiedz
authors: Lilli
authors: L
authors: Knickel
authors: Christiane
authors: C
authors: Engelbertz
authors: Florian
authors: F
authors: Lüders
authors: Katrin
authors: K
authors: Gebauer
authors: Wolfgang E
authors: WE
authors: Berdel
authors: Johannes
authors: J
authors: Waltenberger
authors: Holger
authors: H
authors: Reinecke
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors