Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit

  • Cyriacus Anaele Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
  • Gabreila Suarez Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
  • Sofia Kennedy-Prieto Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
  • Mamoun Bashir Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
  • Melvin Laski Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
  • Shengping Yang Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
Keywords: Acute kidney injury, intensive care unit, critically ill patients, acute renal failure

Abstract

Background: Acute kidney injury (AKI) is often one component of multiple organ failure (MOF) in the intensive care unit (ICU). However, not all patients with MOF develop AKI, and AKI may develop in the absence of MOF. We compared the impact of AKI alone and in combination with MOF on the survival of patients admitted to a large tertiary care medical intensive care unit (MICU). 

Methods: We abstracted data from the electronic medical records of patients admitted to the MICU from April 2012 through June 2013 and categorized patients as either high-risk or low- risk status based on use of vasopressor support or mechanical ventilation during the ICU stay. The outcomes we considered were in-hospital, 30-day, 90-day, 180-day, and 1-year mortality. Results: Of the 834 critically ill patients, 743 (89%) developed some degree of AKI. Ninety-one percent of the high-risk cohort developed AKI and 87% of the low-risk cohort developed AKI. Patients with AKI had higher mortality at 1-year than patients without AKI (adjusted odds ratio [OR], 2.5; 95% confidence interval [CI], 1.38 to 4.53); P interaction 0.0026).  Hospital mortality was greater for high-risk patients without AKI than for low-risk patients with AKI.

Conclusion: Acute kidney injury occurs at similar frequency in high and low-risk ICU patients and has significant impact on survival in both groups.  Cardiovascular collapse or respiratory failure has greater impact on short term mortality than AKI, but this effect diminishes over time. Conversely, the impact of AKI on mortality increased over time and remained an independent risk factor for mortality. 

Downloads

Download data is not yet available.

References

Sileanu FE, Murugan R, Lucko N, Clermont G, Kane-Gill SL, Handler SM, Kellum JA. AKI in low-risk versus high-risk patients in intensive care. Clin J Am Soc Nephrol 2015 Feb 6, 10(2):187-96.doi: 10.2215/CJN.03200314.Epub 2014 Nov 25.

Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012:2: 1-38.

MacLeod A: NCEPOD report on acute kidney injury-must do better. Lancet 374: 1405–1406, 2009

Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005:294(7):813-818

Cartin-Ceba R, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET. Risk factors for development of acute kidney injury in crically ill patients. Crit Care Res Pract. 2012; 2012:691013.

Sandra L. Kane-Gill, Florentina E. Sileanu, Raghavan Murugan, Gregory S. Trietley, Steven M. Handler, John A. Kellum. Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2015;65(6):860-869

Kashani K, Al-Khafaji A, Ardiles T, Artigas A, Bagshaw SM, Bell M, Bihorac A, Birkhahn R, Cely CM, Chawla LS, Davison DL, Feldkamp T, Forni LG, Gong MN, et al. Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care 2013 Feb 6, 17(1):R25. Doi: 10.1186/cc12503.

Hoste EA, McCullough PA, Kashani K, Chawla LS, Joannidis M, Shaw AD, Feldkamp T, Uettwiller-Geiger DL, McCarthy P, Shi J0, Walker MG0, Kellum JA1; Sapphire Investigators. Derivation and validation of cutoffs for clinical use of cell cycle arrest biomarkers. Nephrol Dial Transplant 2014 Nov, 29(11):2054-61. Doi: 10.1093/ndt/gfu292.Epub2014 Sep 18.

Porter CJ, Juurlink I, Bisset LH, Bavakunji R, Mehta RL, Devonald MA. A real-time electronic alert to improve detection of acute kidney injury in a large teaching hospital. Nephrol Dial Transplant 2014 Oct, 29(10):1888-93. Doi: 10.1093/ndt/gfu082. Epub 2014 April 16.

Akinnusi ME, Pineda LA, El Solh, AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. 2008, Crit Care Med, pp. 151-8.

Olivaros H, Villamor E. Obesity and mortality in critically ill adults: a systematic reiview and meta-analysis. Obesity (2008) 16, 515-521. Doi:10.1038/oby.2007.102

Published
2017-01-16
How to Cite
Anaele, C., Suarez, G., Kennedy-Prieto, S., Bashir, M., Laski, M., & Yang, S. (2017). Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit. The Southwest Respiratory and Critical Care Chronicles, 5(17), 17-31. Retrieved from https://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/362