Risk factors for acute kidney injury requiring renal replacement therapy based on regional registry data

Abstract

Background: Acute kidney injury (AKI) is a common problem in critically ill patients treated in the intensive care unit (ICU) and is associated with high mortality, particularly when renal replacement therapy (RRT) is required. Our aim was to investigate the risk factors for AKI requiring RRT (AKI-RRT). Methods: In our retrospective, multi-centre, observational study, we analysed 14,672 consecutive AKI-RRT patients hospitalized in ICUs in the Silesian Region (Poland) between October 2011 and December 2014. Demographic and clinical data were derived from the Silesian Registry of Anaesthesiology and Intensive Care Departments. Logistic regression was used to select final risk factors for AKI-RRT. The ROC method was used to analyse the value of clinical parameters to predict the risk of AKI-RRT. Results: Of a total of 14,672 patients, 1,234 (8.4%) developed AKI requiring RRT. Overall 59% of patients were males and the median age in the group was 66 (IQR 55-76) years. There were 16 variables that modified the risk of AKI-RRT. The AUROC for the test scored 0.845 (95% CI: 0.84-0.85; P < 0.0001). Conclusions: We found multiple factors that modified the risk of AKI requiring RRT. Chronic kidney disease (CKD) and cardiogenic shock increased, whereas neurological disorders decreased the risk. Measures directed towards AKI prevention should be aimed specifically at patients with cardiological disorders and CKD.