title: Long-term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: a 10-year prospective cohort study.
abstract: BACKGROUND
  Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high in-hospital morbidity and mortality in critically ill patients. Long-term outcomes have received little attention.
  
  
  METHODS
  The aim of this study was to characterize AKI-chronic kidney disease (CKD) nexus in critically ill patients with AKI (RIFLE class F). We performed a single-centre prospective observational study of 425 consecutive critically ill patients with AKI requiring RRT. None of these patients had pre-existing kidney disease. Primary outcomes were vital status and renal function at hospital discharge and at 5 and 10 years of follow-up.
  
  
  RESULTS
  The overall in-hospital mortality of the study cohort was 47%, the mortality rates at 1, 5 and 10 years were 65, 75 and 80%, respectively. At hospital discharge, recovery of renal function was complete in 56% of survivors. None of these patients developed CKD during follow-up. Ninety percent of the 100 survivors with partial recovery of renal function had ongoing CKD during long-term follow-up. CKD progressed to end-stage renal disease (ESRD) in 12 patients (3% of the cohort or 5% of survivors). The patients with post-AKICKD had a higher prevalence of hypertension, a higher rate of fatal cardiac diseases and a higher all-cause death rate.
  
  
  CONCLUSIONS
  Long-term survival of critically ill patients with AKI requiring RRT is poor and determined by the development of de novo CKD. There is a need for close follow-up of patients surviving AKI to prevent progressive CKD and to reduce associated lethal cardiac events.
authors: Department of Internal Medicine , University of Munich , Campus-Innenstadt, Munich , Germany.
authors: Helmut
authors: H
authors: Schiffl
authors: Department of Internal Medicine , University of Munich , Campus-Innenstadt, Munich , Germany ; SRH Wald-Klinikum Gera, 2 Medizinische Klinik , Gera , Germany.
authors: Susanne M
authors: SM
authors: Lang
authors: Department of Internal Medicine , University of Munich , Campus-Innenstadt, Munich , Germany.
authors: Rainald
authors: R
authors: Fischer
keywords: acute kidney injury; long-term mortality; risk of chronic kidney disease; survival