Five-year risk of end-stage renal disease among intensive care patients surviving dialysis-requiring acute kidney injury: a nationwide cohort study

Critical Care

Henrik Toft Sørensen³  Bente Jespersen²  Else Tønnesen¹  Martin Berg Johansen³  Christian Fynbo Christiansen³  Henrik Gammelager³ 

[1] Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark;Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark;Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

关键词: renal dialysis;    prognosis;    intensive care units;    end-stage renal disease;    critical care;    cohort studies;    acute kidney injury;   

Others  :  818013
DOI  :  10.1186/cc12824

 received in 2013-02-08, accepted in 2013-07-22,  发布年份 2013

【 摘 要 】

Introduction

Dialysis-requiring acute kidney injury (D-AKI) is common among intensive care unit (ICU) patients. However, follow-up data on the risk of end-stage renal disease (ESRD) among these patients remain sparse. We assessed the short-term and long-term risk of ESRD after D-AKI, compared it with the risk in other ICU patients, and examined the risk within subgroups of ICU patients.

Methods

We used population-based medical registries to identify all adult patients admitted to an ICU in Denmark from 2005 through 2010, who survived for 90 days after ICU admission. D-AKI was defined as needing acute dialysis at or after ICU admission. Subsequent ESRD was defined as a need for chronic dialysis for more than 90 days or a kidney transplant. We computed the cumulative ESRD risk for patients with D-AKI and for other ICU patients, taking into account death as a competing risk, and computed hazard ratios (HRs) using a Cox model adjusted for potential confounders.

Results

We identified 107,937 patients who survived for 90 days after ICU admission. Of these, 3,062 (2.8%) had an episode of D-AKI following ICU admission. The subsequent risk of ESRD up to 180 days after ICU admission was 8.5% for patients with D-AKI, compared with 0.1% for other ICU patients. This corresponds to an adjusted HR of 105.6 (95% confidence interval (CI): 78.1 to 142.9). Among patients who survived 180 days after ICU admission without developing ESRD (n = 103,996), the 181-day to 5-year ESRD risk was 3.8% for patients with D-AKI, compared with 0.3% for other ICU patients, corresponding to an adjusted HR of 6.2 (95% CI: 4.7 to 8.1). During the latter period, the impact of AKI was most pronounced in the youngest patients, aged 15 to 49 years (adjusted HR = 12.8, 95% CI: 6.5 to 25.4) and among patients without preexisting chronic kidney disease (adjusted HR = 11.9, 95% CI: 8.5 to 16.8).

Conclusion

D-AKI is an important risk factor for ESRD for up to five years after ICU admission.

【 授权许可】

   
2013 Gammelager et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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