Impact of acute kidney injury on patient outcome in out-of-hospital cardiac arrest: a prospective observational study

Abstract

Kidney disease occurred in about half of patients successfully resuscitated from OHCA. Presence of AKI, but not RRT, was associated with unfavourable 6-month outcome.

Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest

“…However, many factors should be considered in evaluating the results of the current study. First, there were differences in the baseline characteristics of the study cohorts between the present study and previous ones (e.g., age, male sex, witnessed arrest, bystander CPR, time from CPR to ROSC, and shock after ROSC) [3,4,10,11]. Second, there are insufficient data to determine absolute indications and the optimal timing for initiation of RRT.…”

“…In previous studies, the mortality of the RRT group was not lower than that of the non-RRT group [3,4,10,11]. Winther-Jensen et al reported that the 30-day mortality of a RRT group was significantly higher than that of a non-RRT group in the cohort of OHCA patients [11].…”

“…Winther-Jensen et al reported that the 30-day mortality of a RRT group was significantly higher than that of a non-RRT group in the cohort of OHCA patients [11]. However, Beitland et al reported that the 6-month mortality of a RRT group was not different from that of a non-RRT group in the cohort of patients with AKI after OHCA [4], and Geri et al reported that there were no differences between the RRT and non-RRT groups in a cohort of patients with stage 3 AKI [3]. Considering those results, we compared the mortality between the non-RRT and RRT groups in the different cohorts (all enrolled patients, patients with AKI, and stage 3 patients with AKI).…”

“…Keywords: Renal replacement therapy, Acute kidney injury, Out-of-hospital cardiac arrest, Targeted temperature management, Therapeutic hypothermia Background Acute kidney injury (AKI) develops frequently after out-of-hospital cardiac arrest (OHCA) and is associated with long-term mortality and poor neurological outcomes [1][2][3][4][5][6][7][8]. Similar to critically ill patients, increased AKI severity is associated with increased mortality in OHCA patients [2,4,9]. In contrast, recovery from AKI was a potent predictor of survival and good neurological outcome at discharge [5].…”

Guidelines for post-resuscitation care should include management of acute kidney injury and use of renal replacement therapy

“…Presence of post-arrest AKI is associated with unfavourable outcome, and the chance of survival is reduced proportional to the severity of AKI disease [2]. Despite this, one study showed that OHCA patients treated with RRT had a relatively good prognosis, as 50% were alive after six months, with 89% having good neurological outcome [3].Although there are few clinical studies on AKI after CA, we know that AKI often is associated with hypervolaemia, hyperkalaemia and acidosis, and tight control of these factors may be important in the initial phase after CA. Delayed awakening from coma may be expected in post-arrest AKI due to reduced renal clearance of analgesics and sedatives, and development of uremic encephalopathy.…”