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Kidney Week

Abstract: SA-PO541

Prognostic Tool in Dialysis Treated AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Tanasiychuk, Tatiana, Carmel Medical Center, Haifa, Israel
  • Antebi, Alon, Carmel Medical Center, Haifa, Israel
  • Kushnir, Daniel, Carmel Medical Center, Haifa, Israel
  • Marcuson, Jerom, Carmel Medical Center, Haifa, Israel
  • Gil, Amnon, Carmel Medical Center, Haifa, Israel
  • Gorlachev, Tatyana, Carmel Medical Center, Haifa, Israel
  • Svistunov, Victoria, Carmel Medical Center, Haifa, Israel
  • Abd Elhalim, Muhammad, Carmel Medical Center, Haifa, Israel
  • Sura, Oleg, Carmel Medical Center, Haifa, Israel
  • Frajewicki, Victor, Carmel Medical Center, Haifa, Israel
Background


AKI is a common condition in hospitalized patients, having a mortality which may exceed 50%. Although dialysis may extend life in some subjects with AKI, elderly patients, with multiple comorbidities have a significantly shortened life expectancy. Attempts to identify prognostic models for a more accurate estimation of survival for AKI which was treated by dialysis were not successful. Utility of the "surprise" question to identify chronic dialysis patients with high mortality was reported, but studies on general population of seriously ill patients this question performs poor to modest predictive tool. The aim of our study was to identify the sensitivity of the "surprise" question in patients with unscheduled in-hospital started dialysis.

Methods

Prospective cohort study of all AKI patients who were treated by hemodialysis between January 1st, 2013 and December 31, 2017 in our center. During this period nephrologists had to answer the "surprise" question (Would I be surprised if this patient died in the next 6 months?) regarding every patient with AKI at the day of the first dialysis.

Results

The cohort included 475 patients, 60% males, 60% diabetics, aged 72.8 ± 12.2 (Range 20.6-98.7). In 31% of cases patients suffered from AKI and in 69% from Acute on Chronic Kidney Disease. In 41%, patients started dialysis in an ICU. The 30- days- all- cause mortality was 37% and the 6-months mortality rate 53%. The 7-days mortality was 20%. The Positive Predictive Value of the "surprise" question was 65%, the Negative Predictive Value 58% with a Sensitivity 58% and Specificity 65%.

Conclusion


The "surprise" question showed a weak predictive value for death in AKI patients treated by dialysis. Since patients requiring dialysis have a poor general prognosis, we need more sensitive instruments to choose the right patient for the right treatment avoiding unnecessary and futile treatments.