Pre-existing chronic kidney disease and acute kidney injury among critically ill patients.

Abdalrahim, MS; Khalil, AA; Alramly, M; Alshlool, KN; Abed, MA; Moser, DK

Pre-existing chronic kidney disease and acute kidney injury among critically ill patients.

Abdalrahim, MS Khalil, AA Alramly, M Alshlool, KN Abed, MA Moser, DK

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Heart & lung : the journal of critical care, 2020, 49, (5), pp. 626-629
Issue Date:: 2020-04-27

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Field	Value	Language
dc.contributor.author	Abdalrahim, MS
dc.contributor.author	Khalil, AA
dc.contributor.author	Alramly, M
dc.contributor.author	Alshlool, KN
dc.contributor.author	Abed, MA
dc.contributor.author	Moser, DK
dc.date.accessioned	2020-09-02T01:55:21Z
dc.date.available	2020-04-15
dc.date.available	2020-09-02T01:55:21Z
dc.date.issued	2020-04-27
dc.identifier.citation	Heart & lung : the journal of critical care, 2020, 49, (5), pp. 626-629
dc.identifier.issn	0147-9563
dc.identifier.issn	1527-3288
dc.identifier.uri	http://hdl.handle.net/10453/142489
dc.description.abstract	BACKGROUND:The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common. OBJECTIVES:To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI. METHODS:A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m2 on admission. RESULTS:Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02-1.05;(P<0.001) and AKI (1.68; 95% CI 1.12-2.5;P<0.01) in patients with pre-existing CKD. Only APACHI-II (1.03; 95% CI 1.0-1.1; p < 0.001) was predictive of death in patients without pre-existing CKD. CONCLUSION:Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	Heart & lung : the journal of critical care
dc.relation.isbasedon	10.1016/j.hrtlng.2020.04.013
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology, 1110 Nursing
dc.subject.classification	Nursing
dc.title	Pre-existing chronic kidney disease and acute kidney injury among critically ill patients.
dc.type	Journal Article
utslib.citation.volume	49
utslib.location.activity	United States
utslib.for	1102 Cardiorespiratory Medicine and Haematology
utslib.for	1110 Nursing
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2020-09-02T01:55:14Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	49
utslib.citation.issue	5

Abstract:

BACKGROUND:The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common. OBJECTIVES:To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI. METHODS:A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m2 on admission. RESULTS:Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02-1.05;(P<0.001) and AKI (1.68; 95% CI 1.12-2.5;P<0.01) in patients with pre-existing CKD. Only APACHI-II (1.03; 95% CI 1.0-1.1; p < 0.001) was predictive of death in patients without pre-existing CKD. CONCLUSION:Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality.

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http://hdl.handle.net/10453/142489