TY - JOUR
T1 - Impact of Acute Kidney Injury and CKD on Adverse Outcomes in Critically Ill Septic Patients
AU - Acute Kidney Injury in Critical Illness Study Group
AU - Neyra, Javier A.
AU - Mescia, Federica
AU - Li, Xilong
AU - Adams-Huet, Beverley
AU - Yessayan, Lenar
AU - Yee, Jerry
AU - Toto, Robert D.
AU - Moe, Orson W.
N1 - Funding Information:
This work was presented in part as an abstract at the 2016 annual meeting of the American Society of Nephrology in Chicago, IL. Research reported in this publication was supported by the University of Texas Southwestern Medical Center O'Brien Kidney Research Core Center (NIH, P30 DK079328-06), the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH, UL1TR001105), and the Division of Nephrology and Hypertension of Henry Ford Hospital. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health, the University of Texas Southwestern, or Henry Ford Hospital. JAN was supported by the Ben J. Lipps Research Fellowship Program of the American Society of Nephrology Foundation for Kidney Research and the Truelson Fellowship Fund at UT Southwestern Charles and Jane Pak Center of Mineral Metabolism and Clinical Research. JAN is currently supported by an Early Career Pilot Grant from the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1TR001998.
Funding Information:
This work was presented in part as an abstract at the 2016 annual meeting of the American Society of Nephrology in Chicago, IL. Research reported in this publication was supported by the University of Texas Southwestern Medical Center O’Brien Kidney Research Core Center (NIH, P30 DK079328-06 ), the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH, UL1TR001105 ), and the Division of Nephrology and Hypertension of Henry Ford Hospital . The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health, the University of Texas Southwestern, or Henry Ford Hospital. JAN was supported by the Ben J. Lipps Research Fellowship Program of the American Society of Nephrology Foundation for Kidney Research and the Truelson Fellowship Fund at UT Southwestern Charles and Jane Pak Center of Mineral Metabolism and Clinical Research. JAN is currently supported by an Early Career Pilot Grant from the National Center for Advancing Translational Sciences, National Institutes of Health , through grant UL1TR001998 .
Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2018/11
Y1 - 2018/11
N2 - Introduction: Chronic kidney disease (CKD) and acute kidney injury (AKI) are strongly associated with excess morbidity and mortality and frequently co-occur in critically ill septic patients, but how their interplay affects clinical outcomes is not well elucidated. Methods: We conducted a single-center, retrospective cohort study of 2632 adult patients admitted to the intensive care unit (ICU) with severe sepsis or septic shock. Subjects were classified into 6 groups according to baseline CKD (no-CKD: estimated glomerular filtration rate [eGFR] ≥60; CKD: eGFR 15−59 ml/min per 1.73 m2) and incident AKI by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria (no-AKI, AKI stage 1, AKI stages ≥2) during ICU stay. Study outcomes were 90-day mortality (in hospital or within 90 days of discharge) and incident/progressive CKD. Results: Prevalent CKD was 46% and incident AKI was 57%. Adjusted hazard ratios (95% confidence intervals) for 90-day mortality relative to the reference group of no-CKD/no-AKI were 1.5 (1.1−2.0) in no-CKD/AKI stage 1, 2.4 (1.9−3.1) in no-CKD/AKI stages≥2, 1.1 (0.8−1.4) in CKD/no-AKI, 1.2 (0.9−1.6) in CKD/AKI stage 1, and 2.2 (1.7−2.9) in CKD/AKI stages ≥2. A similar trend was observed for incident/progressive CKD during a median follow-up of 15.3 months. Conclusion: Stage 1 AKI on CKD was not associated with an independent increased risk of adverse outcomes in critically ill septic patients. AKI stages ≥2 on CKD and any level of AKI in no-CKD patients were strongly and independently associated with adverse outcomes. Sepsis-associated stage 1 AKI on CKD may represent distinct underlying pathophysiology, with more prerenal cases and less severe de novo intrinsic damage, which needs further investigation.
AB - Introduction: Chronic kidney disease (CKD) and acute kidney injury (AKI) are strongly associated with excess morbidity and mortality and frequently co-occur in critically ill septic patients, but how their interplay affects clinical outcomes is not well elucidated. Methods: We conducted a single-center, retrospective cohort study of 2632 adult patients admitted to the intensive care unit (ICU) with severe sepsis or septic shock. Subjects were classified into 6 groups according to baseline CKD (no-CKD: estimated glomerular filtration rate [eGFR] ≥60; CKD: eGFR 15−59 ml/min per 1.73 m2) and incident AKI by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria (no-AKI, AKI stage 1, AKI stages ≥2) during ICU stay. Study outcomes were 90-day mortality (in hospital or within 90 days of discharge) and incident/progressive CKD. Results: Prevalent CKD was 46% and incident AKI was 57%. Adjusted hazard ratios (95% confidence intervals) for 90-day mortality relative to the reference group of no-CKD/no-AKI were 1.5 (1.1−2.0) in no-CKD/AKI stage 1, 2.4 (1.9−3.1) in no-CKD/AKI stages≥2, 1.1 (0.8−1.4) in CKD/no-AKI, 1.2 (0.9−1.6) in CKD/AKI stage 1, and 2.2 (1.7−2.9) in CKD/AKI stages ≥2. A similar trend was observed for incident/progressive CKD during a median follow-up of 15.3 months. Conclusion: Stage 1 AKI on CKD was not associated with an independent increased risk of adverse outcomes in critically ill septic patients. AKI stages ≥2 on CKD and any level of AKI in no-CKD patients were strongly and independently associated with adverse outcomes. Sepsis-associated stage 1 AKI on CKD may represent distinct underlying pathophysiology, with more prerenal cases and less severe de novo intrinsic damage, which needs further investigation.
KW - AKI
KW - CKD
KW - mortality
KW - outcomes
KW - sepsis
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U2 - 10.1016/j.ekir.2018.07.016
DO - 10.1016/j.ekir.2018.07.016
M3 - Article
C2 - 30450461
AN - SCOPUS:85054432385
VL - 3
SP - 1344
EP - 1353
JO - Kidney International Reports
JF - Kidney International Reports
SN - 2468-0249
IS - 6
ER -