Long Term Mortality And Risk of End-Stage Renal Disease Following Acute Rrt in Icu Patients

Introduction

In the intensive care unit (ICU) the need for acute renal replacement therapy (aRRT) is associated with high mortality and risk of end-stage renal disease (ESRD). We investigated long term mortality and progression to ESRD in ICU patients requiring aRRT and factors associated to these.

Methods

Retrospective analysis of all adult patients admitted to the general ICU, Rigshospitalet, from 1/1-2005 to 31/12-2012, identified through the ICU database, excluding chronic dialysis patients. ESRD was defined as the need of dialysis >90 days or kidney transplant.

Results

Of 5766 patients included, 931 (16%) received aRRT, 4762 (83%) did not receive any RRT and 73 (1%) only received aRRT during a later ICU admission. The 90-day mortality was 55% for aRRT patients and 22% for those not requiring aRRT (p < 0.001). The median (IQR) age was 61 (49 - 68) for aRRT 90-day survivors and 65 (55 - 73) for aRRT non-survivors (p < 0.001). The median SAPS II score was 53 (43 - 64) for aRRT 90-day survivors and 61 (49 - 74) for aRRT non-survivors (p < 0.001). Characteristics of aRRT patients developing ESRD and those that did not, are displayed in tables 1-3. The 7-year risk of ESRD for patients surviving 90 days after admission was 10% (7 - 14) for aRRT patients as compared to 0.5% (95% CI 0.3-0.9) for those not receiving aRRT (p < 0.001).

Table 1 Baseline characteristics.

Table 2 Preexisting Comorbidity.

Table 3 Primary diagnosis during ICU stay.

Conclusions

The aRRT patients surviving 90 days were younger and less severely ill at ICU admission as compared to the non-survivors. The survivors developing ESRD had more frequently preexisting chronic kidney disease and higher APACHE II scores as compared to those who did not develop ESRD. aRRT patients had increased risk of ESRD up to 7 years after ICU admission, emphasizing the KDIGO recommendations to follow up AKI patients due to their increased risk for CKD.