Background: Acute kidney injury (AKI) during hospitalisation is frequent and associated with adverse outcomes.Aims: To evaluate the association between renal function recovery after AKI and short-term post-discharge mortality.Methods: This is a retrospective study of all AKI episodes codified in the electronic records of a single centre in 2013 and 2014. Epidemiological data and comorbidities at baseline and laboratory values at admission and discharge were collected. Persistent kidney dysfunction after AKI was defined as a last serum creatinine equal or above 1.2-fold over baseline level. Patients were followed for 30 days after discharge.Results: Out of 1720 evaluated patients, 1541 (89%) were analysed. Of them, 869 (56%) recovered renal function. Independent predictors of renal function recovery after AKI were lower baseline estimated glomerular filtration rate (eGFR) (P < 0.001), higher admission eGFR (P < 0.001) and haemoglobin (P = 0.016), milder AKI (P = 0.037), absence of a history of heart failure (P < 0.001) and lower admission blood pressure (P < 0.001). After discharge, 46 (3%) patients died in the first 30 days. Persistent kidney dysfunction was associated (P = 0.01) with and independently predicted (odds ratio 2.6; 95% confidence interval 1.2-5.4; P = 0.01) short-term post-discharge mortality.Conclusions: Persistent kidney dysfunction after an AKI episode is an independent predictor of 30-day post-discharge mortality. This information might help select AKI patients who require closer follow up and monitoring after discharge.
Background and Aims The incidence of acute kidney injury (AKI) during a hospitalization is frequent and worsen the prognosis. Recovery of renal function after AKI has been lightly studied and cut-off for establishing full recovery has not been determined. The aim of the present study is to evaluate the association between different degrees of renal function recovery after AKI and short-term mortality post-discharge. Method This is a retrospective study that included all the AKI codified in the electronic records of our center in 2013 and 2014. We collect epidemiological data and comorbidities at baseline and laboratory values at admission and discharge. To analyze the impact of recovery of renal function after AKI we performed a univariate logistic regression with different cutoff of creatinine after 7 days of the AKI in comparison to baseline. We used the most sensitive cutoff to define recovery and evaluated associated factors (figure 1). Patients were followed during 30 days to assess associated factors to prognosis after AKI. Results We included 1720 patients in this study. After the hospitalization due to AKI, 1194 (69%) entered in the final analysis. Of them 869 (73%) recovered renal function. Factors associated to recovery were age (p=0.01), presence of CKD (p=0.04), basal renal function (p<0.001), history of heart failure (p=0.02), having cognitive impairment (p=0.01), dependence (using Barthel index, p=0.002), renal function at admission (p<0.001), severity of AKI (p<0.001), blood pressure at admission (p=0.02) and hemoglobin at admission (p=0.04). Independent predictors of recovery were basal CKD-EPI (p<0.001), CKD-EPI at admission (p<0.001), severity of AKI (p=0.037), hemoglobin at admission (p=0.016), blood pressure at admission (p<0.001) and history of heart failure (0.001). After discharge, 46 (3%) patients died in the first 30 days. Associated factors to mortality were history of neoplasia (p=0.02), cognitive impairment (p<0.001), Barthel index (p<0.001) and the absence of renal recovery after AKI (defined as reaching a creatinine above 1.2 times of the baseline) (p=0.01). In an adjusted model, renal function recovery independently predicted short term mortality (HR 2.6, 95%CI [1.2-5.4], p=0.01). Conclusion The absence of recovery after an AKI is an independent predictor of 30-day mortality.
Background and Aims Acute Kidney Injury (AKI) is one of the most frequent causes of hospitalization and many factors have been associated to its prognosis and recovery. The role of iron in AKI physiopathology and its influence is not well known. Recent studies have shown that elevated levels of catalytic iron are associated with higher mortality in patients with AKI, however, catalytic iron is not available in usual clinical practice. Ferritin, especially abundant in the liver, is the primary intracellular iron storage protein. A small amount is secreted to the circulation and is an indirect marker of total body iron deposits. In this study we analyze the influence of iron, with ferritin values, in the prognosis of AKI. Method We developed a retrospective, single-center study that enrolled patients with AKI, hospitalized in our center between 2013 and 2014 with iron metabolism values in the first 72 hours after admission. At baseline, we collected demographic information, comorbidities, reason for admission and iron metabolism values (ferritin, transferrin, transferrin saturation index and serum iron). We analyzed variables associated with low and high ferritin values and its impact in AKI long-term prognosis using univariate and multivariable Cox regression. Results Of the 1731 analyzed patients, 833 (48.1%) had ferritin records. The mean age was 78±14 years and 48% of the patients were women. The most frequent comorbidity was hypertension (76%), followed by chronic kidney disease (46%), dyslipidemia (44%), heart failure (31%), diabetes mellitus (29%) and atrial fibrillation (27%). The most frequent reason for admission was infection (35%) followed by AKI (19%). Ferritin values differed significantly according age (p<0.0001), sex (p=0.024), diabetes (0.012), hypertension (p=0.002), neoplasia (p=0.016), reason for admission (p=0.018), baseline CKD-EPI (0.012) and lactate at admission (p<0.0001). During the hospitalization, 165 (20%) patients died. Factor associated to mortality were ferritin>500 ng/ml (p=0.013), lactate at admission (p<0.001), age (p=0.045), hypertension (p=0.014), dyslipidemia (p<0.001), ischemic heart disease (p=0.006), chronic kidney disease (p=0.001), baseline CKD-EPI (p=0.01), atrial fibrillation (p=0.005), neoplasia (p=0.023), Barthel index (p<0.001) and hemoglobin (p=0.006) and bicarbonate (p=0.012) at admission. Multivariate logistic regression demonstrated that ferritin levels over 500 ng/mL was an independent predictor of mortality (1.6 [1,1-2,3] HR [CI 95%]) (p=0.013). Conclusion Ferritin values higher than 500 ng/mL independently predicts mortality in patients admitted with AKI.
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