Chronic kidney disease rather than illness severity predicts medium- to long-term mortality and renal outcome after acute kidney injury

Mark Findlay, Ken Donaldson, Sue Robertson, Alison Almond, Robert Flynn, Chris Isles (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

BACKGROUND: Acute kidney injury (AKI) requiring renal replacement therapy (RRT) continues to be associated with a hospital mortality of ∼50%. Longer-term outcomes have been less well studied. We sought to determine the influence of ventilation and of underlying chronic kidney disease (CKD) on medium and longterm mortality and renal outcomes.

METHODS: All patients requiring RRT for AKI in south west Scotland between 1 January 1994 and 31 December 2005 were followed prospectively. Survival of patients who were and were not ventilated and of those with and without underlying CKD was compared by odds ratio (OR), adjusting for age and sex. Renal outcomes were determined by interrogation of our biochemistry database.

RESULTS: Three hundred and ninety-six patients with AKI received RRT. One hundred and seventy-six (44%) were ventilated and 98 (25%) had underlying CKD. Patients who required ventilation had a significantly worse 90-day survival than those who did not (OR 2.10 for death; 95% CI 1.34, 3.29) whereas underlying CKD did not predict such an early adverse outcome (OR 1.49; 95% CI 0.89, 2.50). By 5 years, patients who had been ventilated during the acute illness were no longer at increased risk (OR 0.79; 95% CI 0.38, 1.62) whereas the adverse effect of underlying CKD was statistically significant (OR 6.05; 95% CI 2.23, 16.5). Underlying CKD was also a strong predictor of the need for RRT during follow-up.

CONCLUSION: In an unselected series of patients with AKI requiring RRT, underlying CKD rather than illness severity predicted medium- to long-term mortality.

Original languageEnglish
Pages (from-to)594-598
Number of pages5
JournalNephrology Dialysis Transplantation
Volume30
Issue number4
Early online date14 May 2014
DOIs
Publication statusPublished - Apr 2015

Keywords

  • Acute kidney injury
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Odds ratio
  • Prognosis
  • Prospective studies
  • Renal insufficiency, Chronic
  • Renal replacement therapy
  • Scotland
  • Severity of illness index
  • Survival rate
  • Young adult

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