Kidney Week

Abstract: TH-PO038

Trajectories of AKI in Chronic Critical Illness After Sepsis

Session Information

• AKI: Epidemiology, Risk Factors, Prevention
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Ozrazgat-baslanti, Tezcan, University of Florida, Gainesville, Florida, United States

Tezcan Ozrazgat-baslanti,

• Loftus, Tyler J., University of Florida Health, Gainesville, Florida, United States

Tyler J. Loftus,

• Wu, Quran, University of Florida, Gainesville, Florida, United States

Quran Wu,

• Wang, Zhongkai, University of Florida, Gainesville, Florida, United States

Zhongkai Wang,

• Lysak, Nicholas, University of Florida, Gainesville, Florida, United States

Nicholas Lysak,

• Sautina, Laura, University of Florida, Gainesville, Florida, United States

Laura Sautina,

• Brakenridge, Scott, University of Florida, Gainesville, Florida, United States

Scott Brakenridge,

• Brumback, Babette A., University of Florida, Gainesville, Florida, United States

Babette A. Brumback,

• Efron, Philip A., University of Florida, Gainesville, Florida, United States

Philip A. Efron,

• Moldawer, Lyle L., University of Florida, Gainesville, Florida, United States

Lyle L. Moldawer,

• Moore, Frederick A., University of Florida, Gainesville, Florida, United States

Frederick A. Moore,

• Segal, Mark S., University of Florida, Gainesville, Florida, United States

Mark S. Segal,

• Bihorac, Azra, University of Florida, Gainesville, Florida, United States

Azra Bihorac,

Group or Team Name

• Sepsis and Critical Illness Research Center Investigators

Background

Acute kidney injury (AKI) is one of the most common complications among hospitalized patients. Besides the severity of an initial episode of AKI, the timing and duration of renal recovery are required to characterize the natural history of this complex condition and its effect on kidney health. We have determined the epidemiology of persistent AKI and renal recovery, the development of chronic critical illness (CCI), hospital outcomes, and long-term survival in sepsis patients. We hypothesize that patients with persistent AKI, especially those without renal recovery, have worse hospital and long-term outcomes after sepsis.

Methods

In the prospective observational study of 245 sepsis patients, AKI types were adjudicated using KDIGO criteria and ADQI recommendations. In contrast to rapidly reversed AKI, persistent AKI is characterized by the persistence of KDIGO creatinine beyond 48 hours of the onset. Patients whose renal function did not completely recover at discharge were considered to have no recovery. Development of CCI and six-month survival were compared using Fisher's exact and log-rank test, respectively.

Results

Two percent (6/245) had preexisting end-stage renal disease (ESRD) and 15% (36/245) had pre-existing chronic kidney disease (CKD). Among non-ESRD subjects, while about 46% (109/239) developed AKI within 48 hours of sepsis onset, overall 59% (140/239) developed AKI; 28% (39/140) having rapidly reversed AKI and 72% (101/140) having persistent AKI. Among 101 patients who had persistent AKI, 41% (58/140) did not recover at discharge and they had had longer ICU stay, more days on mechanical ventilation, greater prevalence of CCI (55%), and higher hospital mortality (27%). Patients with no recovery had lower 6-month cumulative survival (43%) compared to patients with recovery (88%) and no AKI (94%) (p<0.0001). Among CCI patients, survival was significantly worse for patients with no complete recovery compared to patients who recovered (p=0.0003) or did not develop AKI among patients with CCI (p=0.0001). Among non-CCI patients survival was similar across groups.

Conclusion

Among critically ill septic patients, persistent AKI and absence of renal recovery are significant risk factors for adverse outcomes and long-term mortality.

Funding

• Other NIH Support