Prognostic indicators of adverse renal outcome and death in acute kidney injury hospital survivors

Abstract

Introduction: Data regarding prognostic factors of post-discharge mortality and adverse renal function outcome in acute kidney injury (AKI) hospital survivors are scarce and controversial. Objectives: We aimed to identify predictors of post-discharge mortality and adverse renal function outcome in AKI hospital survivors. Patients and Methods: The study group consisted of 84 AKI hospital survivors admitted to the tertiary medical center during 2-year period. Baseline clinical parameters, with renal outcome 3 months after discharge and 6-month mortality were evaluated. According survival and renal function outcome, patients were divided into two groups. Results: Patients who did not recover renal function were statistically significantly older (P < 0.007) with higher Charlson comorbidity index (CCI) score (P < 0.000) and more likely to have anuria and oliguria (P = 0.008) compared to those with recovery. Deceased AKI patients were statistically significantly older (P < 0.000), with higher CCI score (P < 0.000), greater prevalence of sepsis (P =0.004), higher levels of C-reactive protein (CRP) (P < 0.017) and ferritin (P < 0.051) and lower concentrations of albumin (P<0.01) compared to survivors. By multivariate analysis, independent predictors of adverse renal outcome were female gender (P =0.033), increasing CCI (P =0.000), presence of pre-existing chronic kidney disease (P =0.000) and diabetes mellitus (P =0.019) as well as acute decompensated heart failure (ADHF) (P =0.032), while protective factor for renal function outcome was higher urine output (P =0.009). Independent predictors of post-discharge mortality were female gender (P =0.04), higher CCI score (P =0.001) and sepsis (P =0.034). Conclusion: Female AKI hospital survivors with increasing burden of comorbidities, diagnosis of sepsis and ADHF seem to be at high-risk for poor post-discharge outcome.

Predictors of mortality in acute kidney injury patients admitted to medicine intensive care unit in a Rural Tertiary Care Hospital

“…In previous studies, a mortality rate of 35.9%, 38.5%, and 58% was reported by Peres et al ., Oluseyi et al ., and Hamzić-Mehmedbašić et al ., respectively. [ 12 13 14 ] The variation in the mortality rate observed in these studies may be explained by the difference in the study populations, ICU settings, cause of ICU admission and underlying diseases, or by the nonuniform criteria used for defining AKI in different studies.…”

Influence of variation of the serum creatinine on outcomes of patient with acute kidney injury

“…Moreover, it was verified that throughout of follow-up in the medical clinic the creatinine clearance of patients was progressively increasing until discharge, situation favorable for recovery of renal function (10) . The Charlson Index can be beneficial, not only to predict risk to death due comorbidities, but to predict adverse outcome of kidney function of patients with acute kidney injury (13) . In those patients that evolved to death, the injury or renal failure had present primarily during follow-up, showing positive association (p<0.001).…”

“…Currently, the disparities observed between ethnics and racial groups are clearly influenced by genetic susceptibility, socioeconomic status, choice of life style and/or environmental exposition. Ethnic minority groups can be predisposed to microalbumine or macroalbumine, which is common in those individuals with diabetes mellitus (13) . However, there is a rising body of evidence suggesting that individuals of certain ethnics and racial origins have more susceptibility to develop diabetes and her complications macro and microvascular such renal dysfunction, as described in the present study.…”

Comparative study of community acute kidney injury in young patients versus elderly patients in an internal medicine department in Abidjan (Côte d’Ivoire)

“…The largest proportion in our study could be explained by the delay in the management of our patients related to the precarious socio-economic conditions of these and the lack of social security system. Factors such as sepsis, hypertension and cancer seem associated with the non recovery of renal function during AKI (35,36).…”