Alcántara MCI, Esparza CJG, Visoso PP, Rodríguez GB, Romero AEE, Zarate-Rodríguez PAJ

Language: Spanish
References: 26
Page: 280-285
PDF size: 230.77 Kb.

ABSTRACT

Introduction: Renal failure is the third most frequent organ dysfunction in patients admitted to the hospital and Intensive Care Unit; survival of critically ill patients with acute kidney injury is approximately 70%, but data in critically ill patients with chronic kidney disease are scarce. Objective: To contrast the medium-term survival of critically ill patients with normal renal function, acute kidney injury and chronic kidney disease. Material and methods: All patients consecutively admitted to the Intensive Care Unit from January 01 to December 31, 2018, were chosen, renal function was diagnosed on admission, they were followed up for 90 days and survival between the three groups was contrasted. Results: Of the 355 patients for the final analysis, 184 (51.8%) were diagnosed with normal renal function, 96 (27.1%) acute kidney injury, and 75 (21.1%) chronic kidney disease on admission to the Intensive Care Unit. Age was higher in the acute kidney injury and chronic kidney disease groups than in the normal renal function group (64.0 ± 17.6 and 67.8 ± 16.3 vs 56.7 ± 18.5 years, p = 0.000), the percentage of women was lower in the group acute kidney injury and chronic kidney disease than in the normal renal function group (46/96 [47.9%] y 25/75 [47.6% vs 122//184 [63.3%], p = 0.001). Survival was lower in the acute kidney injury and chronic kidney disease groups compared to the normal kidney function group (66/96 [68.75%] and 49/75 [65.33%] vs 150/184 [81.5%], Logrank test = 0.007). Conclusions: The medium-term survival of critically ill patients with acute kidney injury and chronic kidney disease on admission to the intensive care unit is low compared to the group with normal kidney function.

REFERENCES

1. Pedersen PB, Hrobjartsson A, Nielsen DL, Henriksen DP, Brabrand M, Lassen AT. Prevalence and prognosis of acutely ill patients with organ failure at arrival to hospital: A systematic review. PLoS One. 2018;13(11):e0206610. doi: 10.1371/journal.pone.0206610.

2. Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105-1122. doi: 10.1007/s00134-017-4867-0.

3. Chávez-Iñiguez JS, García-García G, Lombardi R. Epidemiología y desenlaces de la lesión renal aguda en Latinoamérica. Gac Med Mex. 2018;154(Supp 1):S6-S14. Spanish. doi: 10.24875/GMM.M18000067.

4. Priyamvada PS, Jayasurya R, Shankar V, Parameswaran S. Epidemiology and outcomes of acute kidney injury in critically ill: experience from a Tertiary Care Center. Indian J Nephrol. 2018;28(6):413-420. doi: 10.4103/ijn.IJN_191_17.

5. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-1423. doi: 10.1007/s00134-015-3934-7.

6. De Rosa S, Samoni S, Villa G, Ronco C. Management of chronic kidney disease patients in the intensive care unit: mixing acute and chronic illness. Blood Purif. 2017;43(1-3):151-162. doi: 10.1159/000452650.

7. Hotchkiss JR, Palevsky PM. Care of the critically ill patient with advanced chronic kidney disease or end-stage renal disease. Curr Opin Crit Care. 2012;18(6):599-606. doi: 10.1097/MCC.0b013e32835a1c59.

8. Malhotra R, Kashani KB, Macedo E, Kim J, Bouchard J, Wynn S, et al. A risk prediction score for acute kidney injury in the intensive care unit. Nephrol Dial Transplant. 2017;32(5):814-822. doi: 10.1093/ndt/gfx026.

9. O'Brien Z, Cass A, Cole L, Finfer S, Gallagher M, McArthur C, et al. Sex and mortality in septic severe acute kidney injury. J Crit Care. 2019;49:70-76. doi: 10.1016/j.jcrc.2018.10.017.

10. See EJ, Jayasinghe K, Glassford N, Bailey M, Johnson DW, Polkinghorne KR, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019;95(1):160-172. doi: 10.1016/j.kint.2018.08.036.

11. Elseviers MM, Lins RL, Van der Niepen P, Hoste E, Malbrain ML, Damas P, Devriendt J; SHARF investigators. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care. 2010;14(6):R221. doi: 10.1186/cc9355.

12. Geri G, Stengel B, Jacquelinet C, Aegerter P, Massy ZA, Vieillard-Baron A; PREDICT investigators. Prediction of chronic kidney disease after acute kidney injury in ICU patients: study protocol for the PREDICT multicenter prospective observational study. Ann Intensive Care. 2018;8(1):77. doi: 10.1186/s13613-018-0421-7.

13. Ortiz-Soriano V, Neyra JA. The impact of acute kidney injury on frailty status in critical illness survivors-is there enough evidence? J Emerg Crit Care Med. 2018;2:93. doi: 10.21037/jeccm.2018.10.17.

14. Liu C, Peng Z, Dong Y, Li Z, Song X, Liu X, et al. Continuous renal replacement therapy liberation and outcomes of critically ill patients with acute kidney injury. Mayo Clin Proc. 2021;96(11):2757-2767. doi: 10.1016/j.mayocp.2021.05.031.

15. Negi S, Koreeda D, Kobayashi S, Yano T, Tatsuta K, Mima T, et al. Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies. Semin Dial. 2018;31(5):519-527. doi: 10.1111/sdi.12705.

16. Odutayo A, Wong CX, Farkouh M, Altman DG, Hopewell S, Emdin CA, et al. AKI and long-term risk for cardiovascular events and mortality. J Am Soc Nephrol. 2017;28(1):377-387. doi: 10.1681/ASN.2016010105.

17. Chawla LS, Amdur RL, Shaw AD, Faselis C, Palant CE, Kimmel PL. Association between AKI and long-term renal and cardiovascular outcomes in United States veterans. Clin J Am Soc Nephrol. 2014;9(3):448-456. doi: 10.2215/CJN.02440213.

18. Omotoso BA, Turgut F, Abdel-Rahman EM, Xin W, Ma JZ, Scully KW, et al. Dialysis requirement and long-term major adverse cardiovascular events in patients with chronic kidney disease and superimposed acute kidney injury. Nephron. 2017;136(2):95-102. doi: 10.1159/000455749.

19. Yoon BR, Leem AY, Park MS, Kim YS, Chung KS. Optimal timing of initiating continuous renal replacement therapy in septic shock patients with acute kidney injury. Sci Rep. 2019;9(1):11981. doi: 10.1038/s41598-019-48418-4.

20. Collister D, Pannu N, Ye F, James M, Hemmelgarn B, Chui B, et al. Health Care Costs Associated with AKI. Clin J Am Soc Nephrol. 2017;12(11):1733-1743. doi: 10.2215/CJN.00950117.

21. Neyra JA, Mescia F, Li X, Adams-Huet B, Yessayan L, Yee J, et al. Impact of acute kidney injury and CKD on adverse outcomes in critically ill septic patients. Kidney Int Rep. 2018;3(6):1344-1353. doi: 10.1016/j.ekir.2018.07.016.

22. Abdalrahim MS, Khalil AA, Alramly M, Alshlool KN, Abed MA, Moser DK. Pre-existing chronic kidney disease and acute kidney injury among critically ill patients. Heart Lung. 2020;49(5):626-629. doi: 10.1016/j.hrtlng.2020.04.013.

23. Tejera D, Varela F, Acosta D, Figueroa S, Benencio S, Verdaguer C, et al.. Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit. Rev Bras Ter Intensiva. 2017;29(4):444-452. doi: 10.5935/0103-507X.20170061.

24. Martin-Cleary C, Molinero-Casares LM, Ortiz A, Arce-Obieta JM. Development and internal validation of a prediction model for hospital-acquired acute kidney injury. Clin Kidney J. 2019;14(1):309-316. doi: 10.1093/ckj/sfz139.

25. Rimes-Stigare C, Frumento P, Bottai M, Martensson J, Martling CR, Bell M. Long-term mortality and risk factors for development of end-stage renal disease in critically ill patients with and without chronic kidney disease. Crit Care. 2015;19:383. doi: 10.1186/s13054-015-1101-8.

26. Schiffl H. Gender differences in the susceptibility of hospital-acquired acute kidney injury: more questions than answers. Int Urol Nephrol. 2020;52(10):1911-1914. doi: 10.1007/s11255-020-02526-7.