Abstract: SA-PO036

Long-Term Survival in Patients with Septic AKI Is Strongly Influenced by Renal Recovery

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Fiorentino, Marco, University of Pittsburgh, Pittsburgh, United States
  • Tohme, Fadi, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Wang, Shu, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Kellum, John A., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background

Prior studies have found that long-term survival after critical illness is influenced by acute kidney injury (AKI) even in patients who appear to recover renal function. In the current report, we sought to examine the effects of septic AKI on longer-term survival as a function of recovery by discharge.

Methods

We analyzed patients with community-acquired pneumonia from a large multicenter cohort. Patients who developed AKI (KDIGO stages 2- 3) were included and renal recovery was defined as being alive at hospital discharge with return of SCr to within 150% of baseline without dialysis. Our primary outcome was survival up to 3 years analyzed using Kaplan-Meier and Gray’s models.

Results

Stage 2-3 AKI occurred in 262/1742 (15%) patients of which 111 (42.4%) recovered. Patients without recovery were older (75±14 vs 69±15 years, p=0.001), and were more likely to have at least stage 1 AKI on day 1 (83% vs 52%, p<0.001). 11/262 (4%) patients developed ESRD by 1 year of follow-up. Mortality rates were 23.4% (347/1480) for no AKI, 28% (31/111) for AKI with recovery and 44.3% (67/151) for AKI without recovery. Non-recovery at hospital discharge was associated with lower survival compared to no AKI (p<0.001), while patients with recovery had similar survival compared to no AKI (p=0.2)(Figure 1). In a covariate-adjusted Gray’s model, patients who did not recover had a greater hazard for mortality compared to no AKI (HR range 1.05–2.46, overall p=0.001), while recovering patients had similar risk for mortality compared to no AKI (HR range 0.6-0.28, overall p=0.43). Absence of AKI on day 1, no in-hospital RRT, higher Apache III score and higher baseline SCr were associated with recovery after AKI.

Conclusion

Recovery by hospital discharge is associated with improved long-term survival in patients with sepsis-associated AKI. Measures to enhance renal recovery by discharge might reverse the long-term adverse consequences of sepsis-associated AKI

Funding

  • Other NIH Support