AKI Complications in Critically Ill Patients

Abstract

Background and objectives AKI is associated with short-and long-term mortality. However, the exact contribution of AKI complications to the burden of mortality and whether RRT has any beneficial effect on reducing mortality rates in critically ill AKI patients are unknown.Design, setting, participants, & measurements This was a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II project. A total of 18,410 adult patients were enrolled from four intensive care units from a university hospital from 2001 to 2008.Results Overall, 10,245 patients developed AKI. After adjustments, the odds ratios (ORs) for hospital mortality were 1.73 (95% confidence interval [95% CI], 1.52 to 1.98) for AKI stage 1, 1.88 (95% CI, 1.57 to 2.25) for stage 2, and 2.89 (95% CI, 2.41 to 3.46) for stage 3. Totals of 33%, 59%, and 70% of the excess mortality rates associated with AKI stages 1, 2, and 3, respectively, were attenuated by the inclusion of each AKI-related complication in the model. The main burden of excess hospital mortality associated with AKI was attenuated by metabolic acidosis and cumulative fluid balance. Long-term mortality was not attenuated by any of the associated complications. Next, we used two different approaches to explore the associations between RRT, AKI complications, and hospital mortality: multivariate analysis and propensity score matching. In both approaches, the sensitivity analysis for RRT was associated with a better hospital survival in only the following AKI-related subgroups: hyperkalemia (OR, 0.55; 95% CI, 0.35 to 0.85), metabolic acidosis (OR, 0.70; 95% CI, 0.53 to 0.92), cumulative fluid balance .5% of body weight (OR, 0.60; 95% CI, 0.40 to 0.88), and azotemia (OR, 0.57; 95% CI, 0.40 to 0.81).Conclusions A majority of the excess risk of mortality associated with AKI was attenuated by its fluid volume and metabolic complications, particularly in severe AKI. In addition, this study demonstrated that RRT is associated with a better outcome in patients with AKI-related complications.

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

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Identification and Recovery of Renal Function in Non-Dialytic Patients in The Intensive Therapy Scenario

“…17 O quadro séptico e a instabilidade hemodinâmica constituem-se nas mais prevalentes e principais etiologias da LRA. 18 Evidência científica mostrou que de 992 pacientes com diagnós-tico de sepse e choque séptico, 57,7% desenvolveram lesão renal. 19 No estudo ora apresentado, 44,4% dos pacientes evoluíram com sepse e 99, 1% com instabilidade hemodinâmica, fatores que podem ter contribuído para a elevada incidência de LRA.…”

Haste makes waste—Should current guideline recommendations for initiation of renal replacement therapy for acute kidney injury be changed?

“…Outside of the conditions associated with “hard” indications to start RRT, the causal impact of AKI on mortality is presumably low. Studies indicate that only patients with AKI complications have a better survival when RRT was initiated …”