Risk factors and 180-day mortality of acute kidney disease in critically ill patients: A multi-institutional study

Frontiers in Medicine

Medicine

Yu-Tung Huang¹  Hui-Ming Chen¹  Heng-Chih Pan²  Ji-Tseng Fang³  Yung-Chang Chen³  Hsing-Yu Chen⁴ 

[1] Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan;Chang Gung University College of Medicine, Taoyuan, Taiwan;Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan;Chang Gung University College of Medicine, Taoyuan, Taiwan;Division of Nephrology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan;Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan;School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;

关键词: acute kidney injury;    acute kidney disease;    chronic kidney disease;    risk factor;    survival;   

DOI  :  10.3389/fmed.2023.1153670

 received in 2023-01-29, accepted in 2023-03-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundCritically ill patients with acute kidney injury (AKI) have a poor prognosis. Recently, the Acute Disease Quality Initiative (ADQI) proposed to define acute kidney disease (AKD) as acute or subacute damage and/or loss of kidney function post AKI. We aimed to identify the risk factors for the occurrence of AKD and to determine the predictive value of AKD for 180-day mortality in critically ill patients.MethodsWe evaluated 11,045 AKI survivors and 5,178 AKD patients without AKI, who were admitted to the intensive care unit between 1 January 2001 and 31 May 2018, from the Chang Gung Research Database in Taiwan. The primary and secondary outcomes were the occurrence of AKD and 180-day mortality.ResultsThe incidence rate of AKD among AKI patients who did not receive dialysis or died within 90 days was 34.4% (3,797 of 11,045 patients). Multivariable logistic regression analysis indicated that AKI severity, underlying early CKD, chronic liver disease, malignancy, and use of emergency hemodialysis were independent risk factors of AKD, while male gender, higher lactate levels, use of ECMO, and admission to surgical ICU were negatively correlated with AKD. 180-day mortality was highest among AKD patients without AKI during hospitalization (4.4%, 227 of 5,178 patients), followed by AKI with AKD (2.3%, 88 of 3,797 patients) and AKI without AKD (1.6%, 115 of 7,133 patients). AKI with AKD had a borderline significantly increased risk of 180-day mortality (aOR 1.34, 95% CI 1.00–1.78; p = 0.047), while patients with AKD but no preceding AKI episodes had the highest risk (aOR 2.25, 95% CI 1.71–2.97; p < 0.001).ConclusionThe occurrence of AKD adds limited additional prognostic information for risk stratification of survivors among critically ill patients with AKI but could predict prognosis in survivors without prior AKI.

【 授权许可】

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Copyright © 2023 Pan, Chen, Chen, Huang, Fang and Chen.