title: Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study.
abstract: BACKGROUND
  In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes. The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT.
  
  
  METHODS
  We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital. During the study period from August 2004 through December 2012, all consecutive adult patients with AKI-RRT were included. Data were prospectively recorded during the patients' hospital stay and were retrieved from the hospital databases. Data on long-term follow-up were gathered during follow-up consultation or, in the absence of this, by consulting the general physician.
  
  
  RESULTS
  AKI-RRT was reported in 1292 of 23,665 first ICU admissions (5.5 %). Mortality increased from 59.7 % at hospital discharge to 72.1 % at 3 years. A Cox proportional hazards model demonstrated an association of increasing age, severity of illness, and continuous RRT with long-term mortality. Among hospital survivors with reference creatinine measurements, 1-year renal recovery was complete in 48.4 % and incomplete in 32.6 %. Dialysis dependence was reported in 19.0 % and was associated with age, diabetes, chronic kidney disease (CKD), and oliguria at the time of initiation of RRT. MAKE increased from 83.1 % at hospital discharge to 93.7 % at 3 years. Multivariate regression analysis showed no association of classical determinants of outcome (preexisting CKD, timing of initiation of RRT, and RRT modality) with MAKE at 1 year.
  
  
  CONCLUSIONS
  Our study demonstrates poor long-term survival after AKI-RRT that was determined mainly by severity of illness and RRT modality at initiation of RRT. Renal recovery is limited, especially in patients with acute-on-chronic kidney disease, making nephrological follow-up imperative. MAKE is associated mainly with variables determining mortality.
authors: Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium. wouter.decorte@azgroeninge.be.|Department of Anesthesia and Intensive Care Medicine, AZ Groeninge Hospital, Kortrijk, Belgium. wouter.decorte@azgroeninge.be.
authors: Wouter
authors: W
authors: De Corte
authors: Nephrology Division, Ghent University Hospital, Ghent, Belgium.
authors: Annemieke
authors: A
authors: Dhondt
authors: Nephrology Division, Ghent University Hospital, Ghent, Belgium.
authors: Raymond
authors: R
authors: Vanholder
authors: Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.|Research Foundation-Flanders (FWO), Brussels, Belgium.
authors: Jan
authors: J
authors: De Waele
authors: Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
authors: Johan
authors: J
authors: Decruyenaere
authors: Department of Anesthesia, Stedelijk Ziekenhuis, Aalst, Belgium.
authors: Veerle
authors: V
authors: Sergoyne
authors: Department of Anesthesia, Sint-Jozef Ziekenhuis Izegem, Izegem, Belgium.
authors: Joke
authors: J
authors: Vanhalst
authors: Nephrology Division, Ghent University Hospital, Ghent, Belgium.
authors: Stefaan
authors: S
authors: Claus
authors: Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.|Research Foundation-Flanders (FWO), Brussels, Belgium.
authors: Eric A J
authors: EA
authors: Hoste
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009846:Oliguria / Q000453:epidemiology / Q000401:mortality; D063868:Patient Outcome Assessment; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality; D017582:Renal Replacement Therapy / Q000009:adverse effects* / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D017741:Survivors / Q000706:statistics & numerical data
keywords: Acute kidney injury (AKI); Acute-on-chronic kidney failure; Long-term survival; Major adverse kidney events (MAKE); Modality of renal replacement therapy; Renal recovery; Renal replacement therapy (RRT); Timing of renal replacement therapy