Mark Findlay1, Ken Donaldson1, Sue Robertson1, Alison Almond1, Robert Flynn2, Chris Isles3. 1. Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK. 2. Medicines Monitoring Unit, Ninewells Hospital, Dundee DD1 9SY, UK. 3. Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK chris.isles@nhs.net.
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.
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.
Authors: Henriikka Mildh; Ville Pettilä; Anna-Maija Korhonen; Sari Karlsson; Tero Ala-Kokko; Matti Reinikainen; Suvi T Vaara Journal: Ann Intensive Care Date: 2016-11-29 Impact factor: 6.925
Authors: Najlaa G Al-Otaibi; Maryam Zeinelabdin; Mohamed A Shalaby; Norah Khathlan; Ghadi D Mashat; Amal A Zahrani; Sundus Mw NoorSaeed; Nora M Shalabi; Khalid A Alhasan; Sara N Sharief; Amr S Albanna; Jameela A Kari Journal: Saudi Med J Date: 2017-02 Impact factor: 1.484