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Volume 3 Supplement 1

ESICM LIVES 2015

  • Oral presentation
  • Open Access

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

  • 1,
  • 2,
  • 3,
  • 3,
  • 4 and
  • 3
Intensive Care Medicine Experimental20153 (Suppl 1) :A11

https://doi.org/10.1186/2197-425X-3-S1-A11

  • Published:

Keywords

  • Intensive Care Unit
  • Chronic Kidney Disease
  • Renal Replacement Therapy
  • Intensive Care Unit Admission
  • Intensive Care Unit Patient

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.

 

Data available

90 day survivors with ESRD (N = 38)

90 day survivors without ESRD (N = 404)

P

Age (years), median (IQR)

442

61

(52.0 - 70.0)

61

(49 - 68)

0.400

Gender (male)

442

25

(65.8%)

271

(67.1%)

0.999

Days in the ICU, median (IQR)

442

7.2

(3.6 - 15.6)

10.9

(5.7 - 20.9)

0.087

SAPS II score (points), median (IQR)

427

56

(41 - 68)

53

(43 - 64)

0.39

APACHE II score (points), median (IQR)

427

30

(25 - 35)

26

(21 - 31)

0.009

First SOFA (points), median (IQR)

417

11

(8 - 15)

12

(9 - 14)

0.861

MAX SOFA (points), median (IQR)

418

12

(9 - 15)

13

(11 - 16)

0.377

Vasopressor treatment

442

24

(63.2%)

297

(73.5%)

0.279

Mechanical ventilation

442

30

(78.9%)

371

(91.8%)

0.040

Table 2

Preexisting Comorbidity.

 

Data available

90 day survivors with ESRD (N = 38)

90 day survivors without ESRD (N = 404)

P

Chronic kidney disease (non-dialysis)

442

23

(60.5%)

90

(22.3%)

< 0.001

Hypertension

442

14

(36.8%)

119

(29.5%)

0.505

Diabetes

442

6

(15.8%)

56

(13.9%)

0.784

Congestive heart failure

442

4

(10.5%)

39

(9.7%)

0.993

Peripheral vascular disease

442

9

(23.7%)

82

(20.3%)

0.734

Cerebrovascular disease

442

3

(7.9%)

36

(8.9%)

0.968

Malignant neoplasm

442

12

(31.6%)

83

(20.5%)

0.180

Ischemic heart disease

442

4

(10.5%)

29

(7.2%)

0.783

Chronic obstructive pulmonary disease

442

4

(10.5%)

50

(12.4%)

0.928

Table 3

Primary diagnosis during ICU stay.

 

Data available

90 day survivors with ESRD (N = 38)

90 day survivors without ESRD (N = 404)

P

Sepsis

442

7

(18.4%)

112

(27.7%)

0.466

Other infectious diseases

442

6

(15.8%)

20

(5.0%)

0.025

Endocrinological diseases

442

 

(0.0%)

3

(0.7%)

0.868

Cardiovascular diseases

442

3

(7.9%)

43

(10.6%)

0.869

Respiratory diseases

442

9

(23.7%)

66

(16.3%)

0.514

Gastrointestinal or liver diseases

442

2

(5.3%)

11

(2.7%)

0.675

Trauma or poisoning

442

4

(10.5%)

38

(9.4%)

0.975

Other

442

7

(18.4%)

111

(27.4%)

0.483

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.

Authors’ Affiliations

(1)
Copenhagen University Hospital - Rigshospitalet, Department of Intensive Care 4131, Copenhagen, Denmark
(2)
Copenhagen University Hospital, Rigshospitalet, Department of Nephrology 2132, Copenhagen, Denmark
(3)
Copenhagen University Hospital, Rigshospitalet, Department of Intensive Care 4131, Copenhagen, Denmark
(4)
University of Copenhagen, Section of Biostatistics, Copenhagen, Denmark

Copyright

© Lohse et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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