title: Long-term sequelae of severe acute kidney injury in the critically ill patient without comorbidity: a retrospective cohort study.
abstract: OBJECTIVE
  Acute kidney injury (AKI) necessitating renal replacement therapy (RRT) is associated with high mortality and increased risk for end stage renal disease. However, it is unknown if this applies to patients with a preliminary unremarkable medical history. The purpose of this study was to describe overall and renal survival in critically ill patients with AKI necessitating RRT stratified by the presence of comorbidity.
  
  
  METHODS
  A retrospective cohort study was performed, between 1994 and 2010, including all adult critically ill patients with AKI necessitating RRT, stratified by the presence of comorbidity. Logistic regression, survival curve and cox proportional hazards analyses were used to evaluate overall and renal survival. Standardized mortality rate (SMR) analysis was performed to compare long-term survival to the predicted survival in the Dutch population.
  
  
  RESULTS
  Of the 1067 patients included only 96(9.0%) had no comorbidity. Hospital mortality was 56.6% versus 43.8% in patients with and without comorbidity, respectively. In those who survived hospitalization 10-year survival was 45.0% and 86.0%, respectively. Adjusted for age, sex and year of treatment, absence of comorbidity was not associated with hospital mortality (OR=0.74, 95%-CI=0.47-1.15), while absence of comorbidity was associated with better long-term survival (adjusted HR=0.28, 95%-CI = 0.14-0.58). Compared to the Dutch population, patients without comorbidity had a similar mortality risk (SMR=1.6, 95%-CI=0.7-3.2), while this was increased in patients with comorbidity (SMR=4.8, 95%-CI=4.1-5.5). Regarding chronic dialysis dependency, 10-year renal survival rates were 76.0% and 92.9% in patients with and without comorbidity, respectively. Absence of comorbidity was associated with better renal survival (adjusted HR=0.24, 95%-CI=0.07-0.76).
  
  
  CONCLUSIONS
  While hospital mortality remains excessively high, the absence of comorbidity in critically ill patients with RRT-requiring AKI is associated with a relative good long-term prognosis in those who survive hospitalization.
authors: Department of Internal Medicine, Division of Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Gijs
authors: G
authors: Fortrie
authors: Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Susanne
authors: S
authors: Stads
authors: Department of Internal Medicine, Division of Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Albert-Jan H
authors: AJ
authors: Aarnoudse
authors: Department of Internal Medicine, Division of Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Robert
authors: R
authors: Zietse
authors: Department of Internal Medicine, Division of Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Michiel G
authors: MG
authors: Betjes
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality*; D000328:Adult; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D003710:Demography; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D012189:Retrospective Studies; D013997:Time Factors