Obesity, Acute Kidney Injury, and Mortality in Critical Illness.
OBJECTIVE
Although obesity is associated with risk for chronic kidney disease and improved survival, less is known about the associations of obesity with risk of acute kidney injury and post acute kidney injury mortality.


METHODS
In a single-center inception cohort of almost 15,000 critically ill patients, we evaluated the association of obesity with acute kidney injury and acute kidney injury severity, as well as in-hospital and 1-year survival. Acute kidney injury was defined using the Kidney Disease Outcome Quality Initiative criteria.


RESULTS
The acute kidney injury prevalence rates for normal, overweight, class I, II, and III obesity were 18.6%, 20.6%, 22.5%, 24.3%, and 24.0%, respectively, and the adjusted odds ratios of acute kidney injury were 1.18 (95% CI, 1.06-1.31), 1.35 (1.19-1.53), 1.47 (1.25-1.73), and 1.59 (1.31-1.87) when compared with normal weight, respectively. Each 5-kg/m² increase in body mass index was associated with a 10% risk (95% CI, 1.06-1.24; p < 0.001) of more severe acute kidney injury. Within-hospital and 1-year survival rates associated with the acute kidney injury episodes were similar across body mass index categories.


CONCLUSIONS
Obesity is a risk factor for acute kidney injury, which is associated with increased short- and long-term mortality.
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2Division of Health Sciences and Technology, Harvard-MIT , Cambridge, MA. 3School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. 4Institute for Infocomm Research, A*STAR, Singapore, Singapore.
John
J
Danziger
Ken P
KP
Chen
Joon
J
Lee
Mengling
M
Feng
Roger G
RG
Mark
Leo Anthony
LA
Celi
Kenneth J
KJ
Mukamal
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index