Abstract: FR-OR013
Renal Recovery Patterns After AKI Influence Mortality
Session Information
- AKI: Epidemiology, Processes of Care, and Outcomes
November 08, 2019 | Location: 201, Walter E. Washington Convention Center
Abstract Time: 04:54 PM - 05:06 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Zarbock, Alexander, University Hospital Münster, Münster, Germany
- Macedo, Etienne, University of California San Diego, San Diego, California, United States
- Tolwani, Ashita J., University of Alabama at Birmingham, Birmingham, Alabama, United States
- Ostermann, Marlies, Guy's & St Thomas' Hospital, London, United Kingdom
- Bouchard, Josee, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- Mehta, Ravindra L., University of California San Diego Medical Center, La Jolla, California, United States
Group or Team Name
- STIRS group
Background
Renal recovery from acute kidney injury (AKI) in hospitalized patients is variable and non-recovery has been associated with an increased mortality and resource utilization. There is limited information on different patterns of renal recovery following AKI in the ICU setting. We hypothesized that the AKI course and duration in the ICU influences the length of stay and mortality.
Methods
A retrospective multinational cohort study of critically ill adult patients admitted to 4 centers in Germany, UK, and USA was conducted between Jan2014 and Dec2017. We excluded patients who stayed <72hrs in the ICU, patients with ESRD and kidney transplant. AKI was defined by sCr KDIGO criteria and the course characterized as a single episode (SE) or stuttering course (SC) if the patient had multiple AKI during the ICU stay. Recovery of AKI was defined as no longer meeting criteria for even stage 1 AKI. No recovery was defined as an episode of AKI during ICU stay and the last recorded sCr higher than the patient’s reference sCr. The primary outcome was ICU and hospital mortality.
Results
Of 20,560 eligible patients, 9,712 (47.2%) developed AKI, 5,303 (25.8%) at Stage 1, 3,358 (16.3%) Stage 2, 2,290 (11.1%) Stage 3 and 9,613 (46.7 %) no AKI. 2,156 patients (10.5%) received dialysis. 7,086 (74 %) patients had a SE while 2,494 (26 %) patients had a SC. Overall, more than half of the patients recovered from AKI (6,128; 65.9%); 65% in SE versus 58.5% in the SC. Amongst dialyzed patients, 51.8% recovered from AKI; 61.7% of the patients with a SE, 42.1% in the SC. The development of AKI significantly increased length of hospital stay (no AKI: 14.2 (±17.4), SE: 20.3 (±21.1); SC: 40.1 (±38.8) days; p<0.001). Patients with AKI had significantly higher mortality which was influenced by the course (no AKI: 8.2%, SE 14.5%, SC: 19.9%; p<0.001). Patients who recovered from AKI had significantly lower hospital mortality (10.9% versus 25.6%; p<0.05). However, mortality in patients with non-recovery was similar in SC 27.9% and SE (24.6%). Overall, we observed four recover patterns.
Conclusion
We have identified four distinct recovery patterns on the basis of the clinical course. These phenotypes may identify patients amenable to therapeutic intervention. The pattern of renal recovery from AKI in the ICU influences resource utilization and mortality.
Funding
- NIDDK Support –