Long-term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: A 10-year prospective cohort study

Abstract

BackgroundAcute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high in-hospital morbidity and mortality in critically ill patients. Long-term outcomes have received little attention. MethodsThe aim of this study was to characterize AKIchronic kidney disease (CKD) nexus in critically ill patients with AKI (RIFLE class F). We performed a single-centre prospective observational study of 425 consecutive critically ill patients with AKI requiring RRT. None of these patients had pre-existing kidney disease. Primary outcomes were vital status and renal function at hospital discharge and at 5 and 10 years of follow-up. ResultsThe overall in-hospital mortality of the study cohort was 47, the mortality rates at 1, 5 and 10 years were 65, 75 and 80, respectively. At hospital discharge, recovery of renal function was complete in 56 of survivors. None of these patients developed CKD during follow-up. Ninety percent of the 100 survivors with partial recovery of renal function had ongoing CKD during long-term follow-up. CKD progressed to end-stage renal disease (ESRD) in 12 patients (3 of the cohort or 5 of survivors). The patients with post-AKICKD had a higher prevalence of hypertension, a higher rate of fatal cardiac diseases and a higher all-cause death rate. ConclusionLong-term survival of critically ill patients with AKI requiring RRT is poor and determined by the development of de novo CKD. There is a need for close follow-up of patients surviving AKI to prevent progressive CKD and to reduce associated lethal cardiac events. © 2012 The Author.