AKI in Low-Risk versus High-Risk Patients in Intensive Care

Abstract

Background and objectives AKI in critically ill patients is usually part of multiorgan failure. However, nonrenal organ failure may not always precede AKI and patients without evidence of these organ failures may not be at low risk for AKI. This study examined the risk and outcomes associated with AKI in critically ill patients with and without cardiovascular or respiratory organ failures at presentation to the intensive care unit (ICU).Design, setting, participants, & measurements A large, academic medical center database, with records from July 2000 through October 2008, was used and the authors identified a low-risk cohort as patients without cardiovascular and respiratory organ failures defined as not receiving vasopressor support or mechanical ventilation within the first 24 hours of ICU admission. AKI was defined using Kidney Disease Improving Global Outcomes criteria. The primary end points were moderate to severe AKI (stages 2-3) and risk-adjusted hospital mortality.Results Of 40,152 critically ill patients, 44.9% received neither vasopressors nor mechanical ventilation on ICU day 1. Stages 2-3 AKI occurred less frequently in the low-risk patients versus high-risk patients within 24 hours (14.3% versus 29.1%) and within 1 week (25.7% versus 51.7%) of ICU admission. Patients developing AKI in both risk groups had higher risk of death before hospital discharge. However, the adjusted odds of hospital mortality were greater (odds ratio, 2.99; 95% confidence interval, 2.62 to 3.41) when AKI occurred in low-risk patients compared with those with respiratory or cardiovascular failures (odds ratio, 1.19; 95% confidence interval, 1.09 to 1.3); interaction P,0.001.Conclusions Patients admitted to ICU without respiratory or cardiovascular failure have a substantial likelihood of developing AKI. Although survival for low-risk patients is better than for high-risk patients, the relative increase in mortality associated with AKI is actually greater for low-risk patients. Strategies aimed at preventing AKI should not exclude ICU patients without cardiovascular or respiratory organ failures.

Classifying AKI by Urine Output versus Serum Creatinine Level

“…16 Baseline, admission, and reference SC were determined as previously described. 17,18 We classified patients according to the maximum KDIGO criteria 19 met during hospitalization using SC and UO criteria.…”

Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome

“…Our findings are consistent with the previous studies performed in ICU in younger populations that have reported that AKI is more frequently observed in severe and septic patients. 1,2,17,18 There are few studies on AKI in elderly patients admitted to ICU from developing countries. In India, researchers also found that underlying chronic illness, presence of cardiac failure, and sepsis were associated with AKI and poor outcome among the elderly population in a hospital-based study.…”

“…Acute kidney injury (AKI) is a common and important occurrence in intensive care units (ICU), 1 and several studies support the statement that the elderly patient is at the highest risk of AKI, which is associated with considerable mortality (15%-40%). 2 The elderly population is growing globally and, consequently, it has been accompanied by an increase in the incidence of AKI.…”

“…It is widely recognized that AKI leads to significant impact on morbidity, increased length of stay, hospital costs, and poorer outcomes among critically ill patients, but these findings are scarce in developing countries. [1][2][3][4][5]8,9,12 Overall inhospital mortality rates among critically ill patients are high, exceeding 50% and reaching 80%, depending on the clinical conditions, comorbidities, and need for renal replacement therapy. However, few studies have examined the association between AKI and in-ICU mortality in elderly patients.…”

Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit

“…Sileanu et al previously demonstrated that, among individuals admitted to any ICU setting, low-risk patients with AKI had higher mortality than high-risk patients without AKI. 1 We sought to compare Sileanu's results with the mortality of our study population which was limited to patients admitted to the medical intensive care unit (MICU). We also compared the mortality outcomes of patients who developed different stages of AKI defined by Acute Kidney Injury Network (AKIN) criteria.…”