Kidney Week

Abstract: FR-PO065

Quality of Life and Long-Term Survival After Persistent AKI in Sepsis Patients

Session Information

• AKI: Clinical Outcomes, Trials
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

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,

• 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,

• Gardner, Anna, University of Florida, Gainesville, Florida, United States

Anna Gardner,

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

Frederick A. Moore,

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

Lyle L. Moldawer,

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

Mark S. Segal,

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

Azra Bihorac,

Background

Acute kidney injury (AKI) is one of the most common complications among hospitalized patients. It is important to consider the duration of renal recovery in order to characterize the natural history of this complex condition and its effect on kidney health and long term functional status. We have determined the epidemiology of persistent AKI and its effect on long-term functional status and survival in sepsis patients.

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. The Zubrod Scale has been used to measure and compare the performance status of a patient’s ambulatory nature and Zubrod score of 0 indicated that patients were fully active. One-year survival was compared using log-rank test and Cox proportional hazards model was fit to examine association between AKI type and long-term mortality.

Results

Two percent (6/245) had preexisting end-stage renal disease (ESRD) and 15% (36/245) had pre-existing chronic kidney disease (CKD). Sixty-two percent of the study population developed AKI. Only one third of AKI episodes rapidly reversed within 48 hours and had sustained renal recovery at discharge while the remaining 68% had persistent AKI. Prevalence of 1 year mortality in patients with persistent AKI (44%) was significantly higher than patients with rapidly reversed AKI (11%) and patients who did not develop AKI (9%). Percentage of those who were fully active and able to carry out activities without restrictions at 1 year of sepsis onset were only 8% among for patients with persistent AKI, whereas it was 29% for both patients who had rapidly reversed AKI and those who did not develop AKI . Hazard rate (HR) was about five-fold for persistent AKI group (HR 5.38, 95% confidence interval 2.74-11.80) compared to patients who did not develop AKI, while there was no evidence of significant difference in hazard ratios of those with rapidly reversed AKI and no AKI.

Conclusion

Among critically ill septic patients, persistent AKI is a significant risk factor for reduced functionality and increased long-term mortality.

Funding

• Other NIH Support