ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients

A S Truche; S Perinel Ragey; B Souweine; S Bailly; L Zafrani; L Bouadma; C Clec'h; M Garrouste-Orgeas; G Lacave; C Schwebel; F Guebre-Egziabher; C Adrie; A S Dumenil; Ph Zaoui; L Argaud; S Jamali; D Goldran Toledano; G Marcotte; J F Timsit; M Darmon

doi:10.1186/s13613-018-0467-6

ICU survival and need of renal replacement therapy with respect to AKI duration in critically ill patients

Ann Intensive Care. 2018 Dec 17;8(1):127. doi: 10.1186/s13613-018-0467-6.

Authors

A S Truche^{1

2

3}, S Perinel Ragey⁴, B Souweine⁵, S Bailly^{1

2}, L Zafrani^{6

7}, L Bouadma⁸, C Clec'h^{9

10}, M Garrouste-Orgeas^{11

12}, G Lacave¹³, C Schwebel², F Guebre-Egziabher³, C Adrie¹⁴, A S Dumenil¹⁵, Ph Zaoui³, L Argaud¹⁶, S Jamali¹⁷, D Goldran Toledano¹⁸, G Marcotte¹⁹, J F Timsit^{1

8}, M Darmon^{20

21

22}

Affiliations

¹ UMR 1137 - IAME Team 5 - DeSCID : Decision SCiences in Infectious Diseases, Control and Care, Inserm/Paris Diderot University, Sorbonne Paris Cité, Paris, France.
² Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, U823, La Tronche, France.
³ Nephrology Dialysis Renal Transplantation, Grenoble University Hospital, La Tronche, France.
⁴ Medical Intensive Care Unit, Croix Rousse Hospital, Lyon University Hospital, Lyon, France.
⁵ Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
⁶ Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France.
⁷ Medicine University, Paris 7 University, Paris, France.
⁸ Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, 75018, Paris, France.
⁹ Intensive Care Unit, AP-HP, Avicenne Hospital, Paris, France.
¹⁰ Medicine University, Paris 13 University, Bobigny, France.
¹¹ Intensive Care Unit, Saint Joseph Hospital Network, Paris, France.
¹² Medicine University, Paris Descartes University, Sorbonne Cite, Paris, France.
¹³ Medical Intensive Care Unit, André Mignot Hospital, Versailles, France.
¹⁴ Physiology Department, Cochin University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP), Paris Descartes University des, Sorbonne Cite, Paris, France.
¹⁵ Medical-Surgical Intensive Care Unit, AP-HP, Antoine Béclère University Hospital, Clamart, France.
¹⁶ Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France.
¹⁷ Critical Care Medicine Unit, Dourdan Hospital, Dourdan, France.
¹⁸ Intensive Care Unit, Gonesse Hospital, Gonesse, France.
¹⁹ Surgical ICU, Edouard Herriot University Hospital, Lyon, France.
²⁰ Medical Intensive Care Unit, AP-HP, Saint Louis Hospital, Paris, France. [email protected].
²¹ Medicine University, Paris 7 University, Paris, France. [email protected].
²² ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris, France. [email protected].

Abstract

Background: Transient and persistent acute kidney injury (AKI) could share similar physiopathological mechanisms. The objective of our study was to assess prognostic impact of AKI duration on ICU mortality.

Design: Retrospective analysis of a prospective database via cause-specific model, with 28-day ICU mortality as primary end point, considering discharge alive as a competing event and taking into account time-dependent nature of renal recovery. Renal recovery was defined as a decrease of at least one KDIGO class compared to the previous day.

Setting: 23 French ICUs.

Patients: Patients of a French multicentric observational cohort were included if they suffered from AKI at ICU admission between 1996 and 2015.

Intervention: None.

Results: A total of 5242 patients were included. Initial severity according to KDIGO creatinine definition was AKI stage 1 for 2458 patients (46.89%), AKI stage 2 for 1181 (22.53%) and AKI stage 3 for 1603 (30.58%). Crude 28-day ICU mortality according to AKI severity was 22.74% (n = 559), 27.69% (n = 327) and 26.26% (n = 421), respectively. Renal recovery was experienced by 3085 patients (58.85%), and its rate was significantly different between AKI severity stages (P < 0.01). Twenty-eight-day ICU mortality was independently lower in patients experiencing renal recovery [CSHR 0.54 (95% CI 0.46-0.63), P < 0.01]. Lastly, RRT requirement was strongly associated with persistent AKI whichever threshold was chosen between day 2 and 7 to delineate transient from persistent AKI.

Conclusions: Short-term renal recovery, according to several definitions, was independently associated with higher mortality and RRT requirement. Moreover, distinction between transient and persistent AKI is consequently a clinically relevant surrogate outcome variable for diagnostic testing in critically ill patients.

Keywords: Acute kidney injury; Epidemiology and outcome; Intensive care unit; Renal recovery; Renal replacement therapy.