John A Kellum1,2, Florentina E Sileanu1,2, Azra Bihorac3, Eric A J Hoste4, Lakhmir S Chawla5. 1. 1 The Center for Critical Care Nephology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 2. 2 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. 3 Department of Anesthesiology, University of Florida, Gainesville, Florida. 4. 4 Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; and. 5. 5 Department of Medicine, Veterans Affairs Medical Center, Washington, DC.
Abstract
RATIONALE: Little is known about how acute kidney injury (AKI) resolves, and whether patterns of reversal of renal dysfunction differ among patients with respect to ultimate recovery. OBJECTIVES: We sought to examine different patterns for AKI reversal that are found in patients and assess how they relate to postdischarge outcomes. METHODS: We studied 16,968 critically ill patients with Kidney Disease Improving Global Outcomes stage 2 or 3 AKI, using an electronic database. Reversal of AKI was defined as alive and no longer meeting criteria for even stage 1. Recovery was defined as reversal at hospital discharge. MEASUREMENTS AND MAIN RESULTS: We observed five patterns. The most common (4,508; 26.6%) was early reversal that was sustained through discharge, but almost as many patients (4,496; 26.5%) had no reversal at all. The remaining patients had late reversal after Day 7 (9.7%); early reversal with one or more relapses, but with ultimate recovery (22.5%); and relapsing without recovery (14.7%). Outcomes for patients with these phenotypes were quite different, with age-adjusted 1-year survival varying from more than 90% for early reversal to less than 40% for patients never reversing. Relapses are common (37.3%), especially in the first 72 hours after reversal, and are associated with a fivefold increased risk for death by 1 year compared with early sustained reversal. CONCLUSIONS: We have identified five distinct recovery phenotypes on the basis of the clinical course over the first week after AKI manifestation. These phenotypes may identify patients amenable to therapeutic intervention. Long-term outcomes are associated with recovery status at hospital discharge.
RATIONALE: Little is known about how acute kidney injury (AKI) resolves, and whether patterns of reversal of renal dysfunction differ among patients with respect to ultimate recovery. OBJECTIVES: We sought to examine different patterns for AKI reversal that are found in patients and assess how they relate to postdischarge outcomes. METHODS: We studied 16,968 critically illpatients with Kidney Disease Improving Global Outcomes stage 2 or 3 AKI, using an electronic database. Reversal of AKI was defined as alive and no longer meeting criteria for even stage 1. Recovery was defined as reversal at hospital discharge. MEASUREMENTS AND MAIN RESULTS: We observed five patterns. The most common (4,508; 26.6%) was early reversal that was sustained through discharge, but almost as many patients (4,496; 26.5%) had no reversal at all. The remaining patients had late reversal after Day 7 (9.7%); early reversal with one or more relapses, but with ultimate recovery (22.5%); and relapsing without recovery (14.7%). Outcomes for patients with these phenotypes were quite different, with age-adjusted 1-year survival varying from more than 90% for early reversal to less than 40% for patients never reversing. Relapses are common (37.3%), especially in the first 72 hours after reversal, and are associated with a fivefold increased risk for death by 1 year compared with early sustained reversal. CONCLUSIONS: We have identified five distinct recovery phenotypes on the basis of the clinical course over the first week after AKI manifestation. These phenotypes may identify patients amenable to therapeutic intervention. Long-term outcomes are associated with recovery status at hospital discharge.
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Authors: Eric A J Hoste; Sean M Bagshaw; Rinaldo Bellomo; Cynthia M Cely; Roos Colman; Dinna N Cruz; Kyriakos Edipidis; Lui G Forni; Charles D Gomersall; Deepak Govil; Patrick M Honoré; Olivier Joannes-Boyau; Michael Joannidis; Anna-Maija Korhonen; Athina Lavrentieva; Ravindra L Mehta; Paul Palevsky; Eric Roessler; Claudio Ronco; Shigehiko Uchino; Jorge A Vazquez; Erick Vidal Andrade; Steve Webb; John A Kellum Journal: Intensive Care Med Date: 2015-07-11 Impact factor: 17.440
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Authors: A Akcan-Arikan; M Zappitelli; L L Loftis; K K Washburn; L S Jefferson; S L Goldstein Journal: Kidney Int Date: 2007-03-28 Impact factor: 10.612
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Authors: Kianoush Kashani; Ali Al-Khafaji; Thomas Ardiles; Antonio Artigas; Sean M Bagshaw; Max Bell; Azra Bihorac; Robert Birkhahn; Cynthia M Cely; Lakhmir S Chawla; Danielle L Davison; Thorsten Feldkamp; Lui G Forni; Michelle Ng Gong; Kyle J Gunnerson; Michael Haase; James Hackett; Patrick M Honore; Eric A J Hoste; Olivier Joannes-Boyau; Michael Joannidis; Patrick Kim; Jay L Koyner; Daniel T Laskowitz; Matthew E Lissauer; Gernot Marx; Peter A McCullough; Scott Mullaney; Marlies Ostermann; Thomas Rimmelé; Nathan I Shapiro; Andrew D Shaw; Jing Shi; Amy M Sprague; Jean-Louis Vincent; Christophe Vinsonneau; Ludwig Wagner; Michael G Walker; R Gentry Wilkerson; Kai Zacharowski; John A Kellum Journal: Crit Care Date: 2013-02-06 Impact factor: 9.097
Authors: Patrick T Murray; Ravindra L Mehta; Andrew Shaw; Claudio Ronco; Zoltan Endre; John A Kellum; Lakhmir S Chawla; Dinna Cruz; Can Ince; Mark D Okusa Journal: Kidney Int Date: 2013-10-09 Impact factor: 10.612
Authors: Mark L Hepokoski; Amy L Bellinghausen; Christine M Bojanowski; Atul Malhotra Journal: Am J Respir Crit Care Med Date: 2018-11-01 Impact factor: 21.405
Authors: Sadudee Peerapornratana; Carlos L Manrique-Caballero; Hernando Gómez; John A Kellum Journal: Kidney Int Date: 2019-06-07 Impact factor: 10.612
Authors: Peter Pickkers; Ravindra L Mehta; Patrick T Murray; Michael Joannidis; Bruce A Molitoris; John A Kellum; Mirjam Bachler; Eric A J Hoste; Oscar Hoiting; Kenneth Krell; Marlies Ostermann; Wim Rozendaal; Miia Valkonen; David Brealey; Albertus Beishuizen; Ferhat Meziani; Raghavan Murugan; Hilde de Geus; Didier Payen; Erik van den Berg; Jacques Arend Journal: JAMA Date: 2018-11-20 Impact factor: 56.272