Clinical predictors of renal non-recovery in acute respiratory distress syndrome

Abstract

Background: Acute kidney injury (AKI) is the most common extra-pulmonary organ failure in acute respiratory distress syndrome (ARDS). Renal recovery after AKI is determined by several factors. The objective of this study was to determine the predictors of renal non-recovery in ARDS patients. Methods: A single center retrospective cohort study of patients with AKI after onset of ARDS. Patients with preexisting chronic kidney disease or intensive care unit stay < 24 h were excluded. AKI staging was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Renal non-recovery was defined as death, dialysis dependence, serum creatinine ≥1.5 times the baseline, or urine output < 0.5 mL/kg/h more than 6 h. Results: Of the 244 patients that met study criteria, 60 (24.6%) had stage I AKI, 66 (27%) had stage II AKI, and 118 (48.4%) had stage III AKI. Of those, 148 (60.7%) patients had renal non-recovery. On multivariable analysis, factors associated with renal non-recovery were a higher stage of AKI (odds ratio [OR] stage II 5.71, 95% confidence interval [CI] 2.17-14.98; OR stage III 45.85, 95% CI 16.27-129.2), delay in the onset of AKI (OR 1.12, 95% CI 1.03-1.21), history of malignancy (OR 4.02, 95% CI 1.59-10.15), septic shock (OR 3.2, 95% CI 1.52-6.76), and a higher tidal volume on day 1-3 of ARDS (OR 1.41, 95% CI 1.05-1.90). Subgroup analysis of survival at day 28 of ARDS also found that higher severity of AKI (OR stage II 8.17, 95% CI 0.84-79.91; OR stage III 111.67, 95% CI 12.69-982.91), delayed onset of AKI (OR 1.12, 95% CI 1.02-1.23), and active malignancy (OR 6.55, 95% CI 1.34-32.04) were significant predictors of renal non-recovery. Conclusions: A higher stage of AKI, delayed onset of AKI, a history of malignancy, septic shock, and a higher tidal volume on day 1-3 of ARDS predicted renal non-recovery in ARDS patients. Among survivors, a higher stage of AKI, delayed onset of AKI, and a history of malignancy were associated with renal non-recovery.

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

“…In our study, only 16 AKI patients (17.4%) achieved recovery of renal function during hospitalization, which was significantly lower than that reported previously (39.3%) [ 25 ]. Our analysis revealed that the delayed onset of AKI, the presence of right heart failure and lower PaO 2 /FiO 2 ratio were associated with an increased likelihood of having non-recovery of renal function.…”

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

“…In our study, only 16 AKI patients (17.4%) had achieved recovery of renal function during the hospitalization, which was signi cantly lower than that reported in a previous study (39.3%) 25 . Our analysis revealed that the delayed onset of AKI, the presence of right heart failure and lower oxygenation ratio were associated with an increased likelihood of having non-recovery of renal function.…”

Management of Acute Kidney Injury in the Setting of Acute Respiratory Distress Syndrome: Review Focusing on Ventilation and Fluid Management Strategies

“…This statistic was not reproduced in the setting of severe ARDS due to influenza A. In a study looking at the outcomes of AKI in patients with severe ARDS due to influenza A, the need for CRRT was associated with increased mortality [26]. In this population, vasopressor use and duration was associated with CRRT utilization and with increased mortality [37].…”

“…A secondary analysis of a multi-center observational study has shown that the presence of AKI was associated with prolonged duration of mechanical ventilation [25]. Patients who received higher TVs on day 1 to 3 upon intubation for ARDS had significantly higher risk of renal nonrecovery [26]. Comparatively, use of lower TVs over the first 3 days of patients diagnosed with ARDS was significantly associated with renal recovery [26].…”

“…Patients who received higher TVs on day 1 to 3 upon intubation for ARDS had significantly higher risk of renal nonrecovery [26]. Comparatively, use of lower TVs over the first 3 days of patients diagnosed with ARDS was significantly associated with renal recovery [26]. Long-term consequences of ventilation strategies in the treatment of ARDS to renal physiology remain to be determined [11].…”