OBJECTIVES: : To examine the effect of severity of acute kidney injury or renal recovery on risk-adjusted mortality across different intensive care unit settings. Acute kidney injury in intensive care unit patients is associated with significant mortality. DESIGN: : Retrospective observational study. SETTING: : There were 325,395 of 617,927 consecutive admissions to all 191 Veterans Affairs ICUs across the country. PATIENTS: : Large national cohort of patients admitted to Veterans Affairs ICUs and who developed acute kidney injury during their intensive care unit stay. MEASUREMENTS AND MAIN RESULTS: : Outcome measures were hospital mortality, and length of stay. Acute kidney injury was defined as a 0.3-mg/dL increase in creatinine relative to intensive care unit admission and categorized into Stage I (0.3 mg/dL to <2 times increase), Stage II (> or =2 and <3 times increase), and Stage III (> or =3 times increase or dialysis requirement). Association of mortality and length of stay with acute kidney injury stages and renal recovery was examined. Overall, 22% (n = 71,486) of patients developed acute kidney injury (Stage I: 17.5%; Stage II: 2.4%; Stage III: 2%); 16.3% patients met acute kidney injury criteria within 48 hrs, with an additional 5.7% after 48 hrs of intensive care unit admission. Acute kidney injury frequency varied between 9% and 30% across intensive care unit admission diagnoses. After adjusting for severity of illness in a model that included urea and creatinine on admission, odds of death increased with increasing severity of acute kidney injury. Stage I odds ratio = 2.2 (95% confidence interval, 2.17-2.30); Stage II odds ratio = 6.1 (95% confidence interval, 5.74, 6.44); and Stage III odds ratio = 8.6 (95% confidence interval, 8.07-9.15). Acute kidney injury patients with sustained elevation of creatinine experienced higher mortality risk than those who recovered. INTERVENTIONS: : None. CONCLUSIONS: : Admission diagnosis and severity of illness influence frequency and severity of acute kidney injury. Small elevations in creatinine in the intensive care unit are associated with increased risk-adjusted mortality across all intensive care unit settings, whereas renal recovery was associated with a protective effect. Strategies to prevent even mild acute kidney injury or promote renal recovery may improve survival.
OBJECTIVES: : To examine the effect of severity of acute kidney injury or renal recovery on risk-adjusted mortality across different intensive care unit settings. Acute kidney injury in intensive care unit patients is associated with significant mortality. DESIGN: : Retrospective observational study. SETTING: : There were 325,395 of 617,927 consecutive admissions to all 191 Veterans Affairs ICUs across the country. PATIENTS: : Large national cohort of patients admitted to Veterans Affairs ICUs and who developed acute kidney injury during their intensive care unit stay. MEASUREMENTS AND MAIN RESULTS: : Outcome measures were hospital mortality, and length of stay. Acute kidney injury was defined as a 0.3-mg/dL increase in creatinine relative to intensive care unit admission and categorized into Stage I (0.3 mg/dL to <2 times increase), Stage II (> or =2 and <3 times increase), and Stage III (> or =3 times increase or dialysis requirement). Association of mortality and length of stay with acute kidney injury stages and renal recovery was examined. Overall, 22% (n = 71,486) of patients developed acute kidney injury (Stage I: 17.5%; Stage II: 2.4%; Stage III: 2%); 16.3% patients met acute kidney injury criteria within 48 hrs, with an additional 5.7% after 48 hrs of intensive care unit admission. Acute kidney injury frequency varied between 9% and 30% across intensive care unit admission diagnoses. After adjusting for severity of illness in a model that included urea and creatinine on admission, odds of death increased with increasing severity of acute kidney injury. Stage I odds ratio = 2.2 (95% confidence interval, 2.17-2.30); Stage II odds ratio = 6.1 (95% confidence interval, 5.74, 6.44); and Stage III odds ratio = 8.6 (95% confidence interval, 8.07-9.15). Acute kidney injurypatients with sustained elevation of creatinine experienced higher mortality risk than those who recovered. INTERVENTIONS: : None. CONCLUSIONS: : Admission diagnosis and severity of illness influence frequency and severity of acute kidney injury. Small elevations in creatinine in the intensive care unit are associated with increased risk-adjusted mortality across all intensive care unit settings, whereas renal recovery was associated with a protective effect. Strategies to prevent even mild acute kidney injury or promote renal recovery may improve survival.
Authors: Jay L Koyner; Steven G Coca; Heather Thiessen-Philbrook; Uptal D Patel; Michael G Shlipak; Amit X Garg; Chirag R Parikh Journal: Am J Kidney Dis Date: 2015-09-16 Impact factor: 8.860
Authors: Rossella Marino; Joachim Struck; Oliver Hartmann; Alan S Maisel; Miriam Rehfeldt; Laura Magrini; Olle Melander; Andreas Bergmann; Salvatore Di Somma Journal: J Nephrol Date: 2014-12-09 Impact factor: 3.902
Authors: Tal Mandelbaum; Joon Lee; Daniel J Scott; Roger G Mark; Atul Malhotra; Michael D Howell; Daniel Talmor Journal: Intensive Care Med Date: 2012-12-07 Impact factor: 17.440
Authors: Benjamin M Fox; Hyo-Wook Gil; Lara Kirkbride-Romeo; Rushita A Bagchi; Sara A Wennersten; Korey R Haefner; Nataliya I Skrypnyk; Carolyn N Brown; Danielle E Soranno; Katja M Gist; Benjamin R Griffin; Anna Jovanovich; Julie A Reisz; Matthew J Wither; Angelo D'Alessandro; Charles L Edelstein; Nathan Clendenen; Timothy A McKinsey; Christopher Altmann; Sarah Faubel Journal: Kidney Int Date: 2019-01-30 Impact factor: 10.612