Long‐term outcome after acute renal replacement therapy: a narrative review

Rimes-Stigare, Claire; Awad, Akil; Mårtensson, Johan; Martling, Claes‐Roland; Bell, Max

doi:10.1111/j.1399-6576.2011.02567.x

Cited by 14 publications

(12 citation statements)

References 47 publications

(54 reference statements)

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“…In contrast, Carl et al 25 reported only 24.6% 1-year survival in a septic study population with AKI. The in-hospital mortality was reported as 38%-69% in a recent review, 26 which matches with our result of ∼60%. Our longterm outcome is slightly better compared to former studies, which reported 62%-84.5% long-term mortality, 10,11,27,28 and is in accordance with Luckraz et al's study, 17 who reported a 5-year mortality of 48%.…”

Section: Discussion Survivalsupporting

confidence: 92%

Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

Faulhaber-Walter

Scholz²,

Haller

et al. 2016

IJNRD

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Background: Critically ill patients with acute kidney injury (AKI) in need of renal replacement therapy (RRT) may have a protracted and often incomplete rehabilitation. Their long-term outcome has rarely been investigated. Study design: Survivors of the HANnover Dialysis OUTcome (HANDOUT) study were evaluated after 5 years for survival, health status, renal function, and quality of life (QoL). The HANDOUT study had examinded mortality and renal recovery of patients with AKI receiving either standard extendend or intensified dialysis after multi organ failure. Results: One hundred fifty-six former HANDOUT participants were analyzed. In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% (86.5% if discharged from hospital). Main causes of death were cardiovascular complications and sepsis. A total of 19 survivors presented to the outpatient department of our clinic and had good renal recovery (mean estimated glomerular filtration rate 72. Quality-adjusted life-years after 5 years were 3.365. Conclusion: Mortality after severe AKI is higher than short-term prospective studies show, and morbidity is significant. Kidney recovery as well as general health remains incomplete. Reduction of QoL is minor, and social rehabilitation is very good. Affectivity is heterogeneous, but most patients experience emotional well-being. In summary, AKI in critically ill patients leads to incomplete rehabilitation but acceptable QoL after 5 years.

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Section: Discussion Survivalsupporting

confidence: 92%

Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

Faulhaber-Walter

Scholz²,

Haller

et al. 2016

IJNRD

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“…The long-term outcome of RRT patients has been more extensively studied [26]. In our study the six-month mortality for RRT patients was 38.9%.…”

Section: Discussionmentioning

confidence: 60%

Six-month survival and quality of life of intensive care patients with acute kidney injury

et al. 2013

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IntroductionAcute kidney injury (AKI) has high incidence among the critically ill and associates with dismal outcome. Not only the long-term survival, but also the quality of life (QOL) of patients with AKI is relevant due to substantial burden of care regarding these patients. We aimed to study the long-term outcome and QOL of patients with AKI treated in intensive care units.MethodsWe conducted a predefined six-month follow-up of adult intensive care unit (ICU) patients from the prospective, observational, multi-centre FINNAKI study. We evaluated the QOL of survivors with the EuroQol (EQ-5D) questionnaire. We included all participating sites with at least 70% rate of QOL measurements in the analysis.ResultsOf the 1,568 study patients, 635 (40.5%, 95% confidence interval (CI) 38.0-43.0%) had AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of the 635 AKI patients, 224 (35.3%), as compared to 154/933 (16.5%) patients without AKI, died within six months. Of the 1,190 survivors, 959 (80.6%) answered the EQ-5D questionnaire at six months. The QOL (median with Interquartile range, IQR) measured with the EQ-5D index and compared to age- and sex-matched general population was: 0.676 (0.520-1.00) versus 0.826 (0.812-0.859) for AKI patients, and 0.690 (0.533-1.00) versus 0.845 (0.812-0.882) for patients without AKI (P <0.001 in both). The EQ-5D at the time of ICU admission was available for 774 (80.7%) of the six-month respondents. We detected a mean increase of 0.017 for non-AKI and of 0.024 for AKI patients in the EQ-5D index (P = 0.728). The EQ-5D visual analogue scores (median with IQR) of patients with AKI (70 (50–83)) and patients without AKI (75 (60–87)) were not different from the age- and sex-matched general population (69 (68–73) and 70 (68–77)).ConclusionsThe health-related quality of life of patients with and without AKI was already lower on ICU admission than that of the age- and sex-matched general population, and did not change significantly during critical illness. Patients with and without AKI rate their subjective health to be as good as age and sex-matched general population despite statistically significantly lower QOL indexes measured by EQ-5D.

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“…International studies reporting long-term mortality for severe AKI vary from 48 to 76% at 1 year, to 84% at 5 years [ 7 , 33 - 35 ]. Recently, investigators in the RENAL-trial reported a total mortality rate of 63% in extended follow -up (up to 4 years) of 90-day survivors of AKI requiring dialysis [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill; a Swedish multi-centre cohort study

et al. 2015

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IntroductionAcute Kidney Injury (AKI) is common in critical ill populations and its association with high short-term mortality is well established. However, long-term risks of death and renal dysfunction are poorly understood and few studies exclude patients with pre-existing renal disease, meaning outcome for de novo AKI has been difficult to elicit. We aimed to compare the long-term risk of Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and mortality in critically ill patients with and without severe de novo AKI.MethodThis cohort study was conducted between 2005 and 2011 in Swedish intensive care units (ICU). Data from 130134 adult patients listed on the Swedish intensive care register-database was linked with other national registries. Patients with pre-existing CKD (4192) and ESRD (1389) were excluded, as were cases (26771) with incomplete data. Patients were classified according to AKI exposure during ICU admission. Outcome in the de novo AKI group was compared to the non-exposed (no-AKI) intensive care control group. Primary outcome was all-cause mortality. Follow-up ranged from one to seven years (median 2.1 years). Secondary outcomes were incidence of CKD and ESRD and median follow-up was 1.3 years.ResultsOf 97 782 patients, 5273 (5.4%) had de novo AKI. These patients had significantly higher crude mortality at one (48.4% vs. 24.6%) and five years (61.8% vs. 39.1%) compared to the control group. The first 30% of deaths in AKI patients occurred within 11 days of ICU admission whilst the 30-centile in the no-AKI group died by 748 days. CKD was significantly more common in AKI survivors at one year (6.0% vs. 0.44%) than in no-AKI group (adjusted incidence rate ratio (IRR) 7.6). AKI patients also had significantly higher rates of ESRD at one (2.0% vs. 0.08%) and at five years (3.9% vs. 0.3%) than those in the comparison group (adjusted IRR 22.5).ConclusionThis large cohort study demonstrated that de novo AKI is associated with increased short and long-term risk of death. AKI is independently associated with increased risk of CKD and ESRD as compared to an ICU control population. Severe de novo AKI survivors should be routinely followed-up and their renal function monitored.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0920-y) contains supplementary material, which is available to authorized users.

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Long‐term outcome after acute renal replacement therapy: a narrative review

Abstract: Early initiation of treatment and fine-tuning of the RRT technique may improve outcome. Consensus regarding AKI definitions, renal function measurement and standardised follow-up regimens are required. Further long-term studies are needed.

Cited by 14 publications

References 47 publications

Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

Six-month survival and quality of life of intensive care patients with acute kidney injury

Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill; a Swedish multi-centre cohort study

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