Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study.

Mildh, Henriikka; Pettilä, Ville Yrjö Olavi; Korhonen, Anna-Maija; Karlsson, Sari; Ala-Kokko, Tero; Reinikainen, Matti; Vaara, Suvi T; FINNAKI, Study Group (2016). Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study. Annals of intensive care, 6(118), p. 118. Springer 10.1186/s13613-016-0218-5

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BACKGROUND The role of an episode of acute kidney injury (AKI) in long-term mortality among initial survivors of critical illness is controversial. We aimed to determine whether AKI is independently associated with decreased survival at 3 years among 30-day survivors of intensive care. RESULTS We included 2336 30-day survivors of intensive care enrolled in the FINNAKI study conducted in seventeen medical-surgical ICUs in Finland during a 5-month period in 2011-2012. The incidence of AKI, defined by the Kidney Disease: Improving Global Outcomes criteria, was 34.6%, and 192 (8.3%) commenced RRT. The 3-year mortality among AKI patients was 23.5% (95% CI 20.6-26.4%) compared to 18.9% (17.0-20.9%) of patients without AKI, p = 0.01. However, after adjustments using Cox proportional hazards regression, AKI was not associated with decreased 3-year survival (HR 1.05; CI 95% 0.86-1.27), whereas advanced age, poor pre-morbid functional performance, and presence of several comorbidities were. Additionally, we matched AKI patients to non-AKI patients 1:1 according to age, gender, presence of severe sepsis, and a propensity score to develop AKI. In the well-balanced matched cohort, 3-year mortality among AKI patients was 136 of 662 (20.5%; 17.5-23.6%) and among matched non-AKI patients 143 of 662 (21.6%; 18.5-24.7%), p = 0.687. Neither AKI nor RRT was associated with decreased survival at 3 years in the sensitivity analyses that excluded patients (1) with chronic kidney disease, (2) with AKI not commenced renal replacement therapy (RRT), and (3) with estimated pre-admission creatinine, chronic kidney disease, or AKI stage 1. CONCLUSION AKI was not an independent risk factor for 3-year mortality among 30-day survivors. Increased 3-year mortality among patients with AKI who survive critical illness may not be related to AKI per se, but rather to advanced age and pre-existing comorbidities.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Pettilä, Ville Yrjö Olavi

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2110-5820

Publisher:

Springer

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

09 Jan 2017 13:42

Last Modified:

15 Jan 2017 02:15

Publisher DOI:

10.1186/s13613-016-0218-5

PubMed ID:

27900737

Uncontrolled Keywords:

Acute kidney injury; Intensive care; Long-term mortality; Renal replacement therapy

BORIS DOI:

10.7892/boris.92338

URI:

https://boris.unibe.ch/id/eprint/92338

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