Daniel H Li1, Ron Wald2, Daniel Blum1, Eric McArthur3, Matthew T James4, Karen E A Burns5, Jan O Friedrich5, Neill K J Adhikari6, Danielle M Nash3, Gerald Lebovic7, Andrea K Harvey1, Stephanie N Dixon8, Samuel A Silver9, Sean M Bagshaw10, William Beaubien-Souligny11. 1. Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada. 2. Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada; ICES, Ontario, Canada. 3. ICES, Ontario, Canada. 4. Division of Nephrology, Foothills Medical Center, Calgary, Canada. 5. Critical Care and Medicine Departments, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 6. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada. 7. Applied Health Research Centre, University of Toronto, Toronto, Canada. 8. ICES, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Canada; Department of Mathematics and Statistics, University of Guelph, Guelph, Canada. 9. ICES, Ontario, Canada; Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Canada. 10. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, School of Public Health, University of Alberta, Edmonton, Canada. 11. Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada; Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada. Electronic address: souligny@umontreal.ca.
Abstract
PURPOSE: Severe acute kidney injury (AKI) is associated with a significant risk of mortality and persistent renal replacement therapy (RRT) dependence. The objective of this study was to develop prediction models for mortality at 90-day and 1-year following RRT initiation in critically ill patients with AKI. METHODS: All patients who commenced RRT in the intensive care unit for AKI at a tertiary care hospital between 2007 and 2014 constituted the development cohort. We evaluated the external validity of our mortality models using data from the multicentre OPTIMAL-AKI study. RESULTS: The development cohort consisted of 594 patients, of whom 320(54%) died and 40 (15% of surviving patients) remained RRT-dependent at 90-day Eleven variables were included in the model to predict 90-day mortality (AUC:0.79, 95%CI:0.76-0.82). The performance of the 90-day mortality model declined upon validation in the OPTIMAL-AKI cohort (AUC:0.61, 95%CI:0.54-0.69) and showed modest calibration. Similar results were obtained for mortality model at 1-year. CONCLUSIONS: Routinely collected variables at the time of RRT initiation have limited ability to predict mortality in critically ill patients with AKI who commence RRT.
PURPOSE: Severe acute kidney injury (AKI) is associated with a significant risk of mortality and persistent renal replacement therapy (RRT) dependence. The objective of this study was to develop prediction models for mortality at 90-day and 1-year following RRT initiation in critically illpatients with AKI. METHODS: All patients who commenced RRT in the intensive care unit for AKI at a tertiary care hospital between 2007 and 2014 constituted the development cohort. We evaluated the external validity of our mortality models using data from the multicentre OPTIMAL-AKI study. RESULTS: The development cohort consisted of 594 patients, of whom 320(54%) died and 40 (15% of surviving patients) remained RRT-dependent at 90-day Eleven variables were included in the model to predict 90-day mortality (AUC:0.79, 95%CI:0.76-0.82). The performance of the 90-day mortality model declined upon validation in the OPTIMAL-AKI cohort (AUC:0.61, 95%CI:0.54-0.69) and showed modest calibration. Similar results were obtained for mortality model at 1-year. CONCLUSIONS: Routinely collected variables at the time of RRT initiation have limited ability to predict mortality in critically illpatients with AKI who commence RRT.
Authors: Abhijat Kitchlu; Joshua Shapiro; Justin Slater; K Scott Brimble; Jade S Dirk; Nivethika Jeyakumar; Stephanie N Dixon; Amit X Garg; Ziv Harel; Andrea Harvey; S Joseph Kim; Samuel A Silver; Ron Wald Journal: Kidney360 Date: 2020-09-17
Authors: Emaad M Abdel-Rahman; Ernst Casimir; Genevieve R Lyons; Jennie Z Ma; Jitendra K Gautam Journal: J Clin Med Date: 2022-06-01 Impact factor: 4.964