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Impaired kidney function at hospital discharge and long-term renal and overall survival in patients who received CRRT

By S. (Susanne) Stads, G. (Gijs) Fortrie, J. (Jasper) van Bommel, R. (Bob) Zietse and M.G.H. (Michiel) Betjes


Background and objectives Critically ill patients with AKI necessitating renal replacement therapy (RRT) have high in-hospital mortality, and survivors are at risk for kidney dysfunction at hospital discharge. The objective was to evaluate the association between impaired kidney function at hospital discharge with long-term renal and overall survival. Design, setting, participants, & measurements Degree of kidney dysfunction in relation to long-term effects on renal survival and patient mortality was investigated in a retrospective cohort study of 1220 adults admitted to an intensive care unit who received continuous RRT between 1994 and 2010. ResultsAfter hospital discharge,median follow-up of survivors (n=475)was 8.5 years (range, 1-17 years); overall mortality ratewas 75%.Only 170 (35%) patientswere dischargedwith an estimated GFR (eGFR)>60 ml/min per 1.73 m2. Multivariate proportional hazards regression analysis demonstrated that age, nonsurgical type of admission, preexisting kidney disease, malignancy, and eGFR of 29-15 ml/min per 1.73 m2 (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.01 to 2.58) and eGFR<15 ml/min per 1.73 m2 (HR, 1.93; 95% CI, 1.23 to 3.02) at discharge were independent predictors of increased mortality. Renal survival was significantly associated with degree of kidney dysfunction at discharge. An eGFR of 29-15 ml/min per 1.73 m2 (HR, 26.26; 95% CI, 5.59 to 123.40) and<15 ml/min per 1.73 m2 (HR, 172.28; 95% CI, 37.72 to 786.75) were independent risk factors for initiation of long-term RRT. Conclusions Most critically ill patients surviving AKI necessitating RRT have impaired kidney function at hospital discharge. An eGFR,30 ml/min per 1.73 m2 is a strong risk factor for decreased long-term survival and poor renal survival

Year: 2013
DOI identifier: 10.2215/CJN.06650712
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