title: Long-term quality of life in critically ill patients with acute kidney injury treated with renal replacement therapy: a matched cohort study.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients and is associated with increased morbidity and mortality. We compared long-term outcome and quality of life (QOL) in ICU patients with AKI treated with renal replacement therapy (RRT) with matched non-AKI-RRT patients.
  
  
  METHODS
  Over 1 year, consecutive adult ICU patients were included in a prospective cohort study. AKI-RRT patients alive at 1 year and 4 years were matched with non-AKI-RRT survivors from the same cohort in a 1:2 (1 year) and 1:1 (4 years) ratio based on gender, age, Acute Physiology and Chronic Health Evaluation II score, and admission category. QOL was assessed by the EuroQoL-5D and the Short Form-36 survey before ICU admission and at 3 months, 1 and 4 years after ICU discharge.
  
  
  RESULTS
  Of 1953 patients, 121 (6.2%) had AKI-RRT. AKI-RRT hospital survivors (44.6%; N = 54) had a 1-year and 4-year survival rate of 87.0% (N = 47) and 64.8% (N = 35), respectively. Forty-seven 1-year AKI-RRT patients were matched with 94 1-year non-AKI-RRT patients. Of 35 4-year survivors, three refused further cooperation, three were lost to follow-up, and one had no control. Finally, 28 4-year AKI-RRT patients were matched with 28 non-AKI-RRT patients. During ICU stay, 1-year and 4-year AKI-RRT patients had more organ dysfunction compared to their respective matches (Sequential Organ Failure Assessment scores 7 versus 5, P < 0.001, and 7 versus 4, P < 0.001). Long-term QOL was, however, comparable between both groups but lower than in the general population. QOL decreased at 3 months, improved after 1 and 4 years but remained under baseline level. One and 4 years after ICU discharge, 19.1% and 28.6% of AKI-RRT survivors remained RRT-dependent, respectively, and 81.8% and 71% of them were willing to undergo ICU admission again if needed.
  
  
  CONCLUSIONS
  In long-term critically ill AKI-RRT survivors, QOL was comparable to matched long-term critically ill non-AKI-RRT survivors, but lower than in the general population. The majority of AKI-RRT patients wanted to be readmitted to the ICU when needed, despite a higher severity of illness compared to matched non-AKI-RRT patients, and despite the fact that one quarter had persistent dialysis dependency.
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. sandra.oeyen@ugent.be.|Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. sandra.oeyen@ugent.be.
authors.forename: Sandra
authors.initials: S
authors.lastname: Oeyen
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. wouter.decorte@azgroeninge.be.|Department of Anaesthesia and Intensive Care Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Courtray, Belgium. wouter.decorte@azgroeninge.be.
authors.forename: Wouter
authors.initials: W
authors.lastname: De Corte
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. dominique.benoit@ugent.be.|Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. dominique.benoit@ugent.be.|Research Foundation - Flanders (FWO), Brussels, Belgium. dominique.benoit@ugent.be.
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.affiliation: I-CHER, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. lieven.annemans@ugent.be.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. annemie.dhondt@ugent.be.|Department of Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. annemie.dhondt@ugent.be.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Dhondt
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. raymond.vanholder@ugent.be.|Department of Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. raymond.vanholder@ugent.be.
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. johan.decruyenaere@ugent.be.|Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. johan.decruyenaere@ugent.be.
authors.forename: Johan
authors.initials: J
authors.lastname: Decruyenaere
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. eric.hoste@ugent.be.|Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. eric.hoste@ugent.be.|Research Foundation - Flanders (FWO), Brussels, Belgium. eric.hoste@ugent.be.
authors.forename: Eric
authors.initials: E
authors.lastname: Hoste
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D001530:Belgium; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011788:Quality of Life; D017582:Renal Replacement Therapy; D017741:Survivors