title: Small acute increases in serum creatinine are associated with decreased long-term survival in the critically ill.
abstract: BACKGROUND
  Long-term outcomes after acute kidney injury (AKI) are poorly described.
  
  
  OBJECTIVE
  We hypothesized that one single episode of minimal (stage 1) AKI is associated with reduced long-term survival compared with no AKI after recovery from critical illness.
  
  
  METHODS
  A prospective cohort of 2,010 intensive care unit (ICU) patients admitted to the ICU between years 2000 and 2009 at a provincial tertiary care hospital. Development of AKI was determined according to the KDIGO classification and mortality up to 10 years after ICU admission was recorded.
  
  
  RESULTS
  Of the 1,844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had no AKI. The 28-day, 1-year, 5-year, and 10-year survival rates were 67.1%, 51.8%, 44.1%, and 36.3% in patients with mild AKI, which was significantly worse compared with the critically ill patients with no AKI at any time (P < 0.01). The unadjusted 10-year mortality hazard ratio was 1.53 (95% confidence interval, 1.2-2.0) for 28-day survivors with stage 1 AKI compared with critically ill patients with no AKI. Adjusted 10-year mortality risk was 1.26 (1.0-1.6). After propensity matching stage 1 AKI with no AKI patients, mild AKI was still significantly associated with decreased 10-year survival (P = 0.036).
  
  
  CONCLUSIONS
  Patients with one episode of mild AKI have significantly lower long-term survival rates than critically ill patients with no AKI. Close medical follow-up of these patients may be warranted and mechanistic research is required to understand how AKI influences long-term events.
authors.affiliation: 1 Centre for Heart Lung Innovation, Division of Critical Care Medicine, and.
authors.forename: Adam
authors.initials: A
authors.lastname: Linder
authors.forename: Chris
authors.initials: C
authors.lastname: Fjell
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.forename: John H
authors.initials: JH
authors.lastname: Boyd
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D001955:British Columbia / Q000453:epidemiology; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood*; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D015415:Biomarkers; D003404:Creatinine