First epidemiological study of acute kidney injury with requirement of renal replacement therapy in Argentina. Intermediate general and renal survival
Keywords:
acute kidney injury; epidemiology; population base; mortality; dialysis dependence; renal dialysis; renal replacement therapy; PAIER-CUDAIO
Abstract
Introduction: Acute kidney injury is a complex, multicausal disorder associated with high mortality and chronic dialysis dependence. The evolution of patients who required renal replacement therapy due to acute kidney injury in Argentina is unknown. Methods: Prospective, observational, longitudinal, multicentric study in individuals over 14 years of age admitted to public hospitals (Province of Santa Fe) with a diagnosis of acute kidney injury and need for renal replacement therapy; study duration: two years (2017 and 2018). Results: Total 255 patients. Frequency 164 ppm/year, 1.85/1000 hospitalizations/year, males 70.98%, age 46.66 years, comorbidities present in 71.37%, hospitalization in critical care 89.02%, extra renal involvement 82.52%. Most frequent causes: arterial hypotension 62.35%, infections 52.73%, nephrotoxic 17.65%. Renal replacement therapy: intermittent hemodialysis 74.51%, sustained low-efficiency dialysis 11.76%, continuous: 13.73%. Evolution: alive at 30 days 116 (45.49%), chronic dialysis dependence 12 (10.34%). Mortality: at 30 days 54.51%, progressing to 65.88% at 420 days. No significant difference in mortality at 30 days according to age, sex, renal replacement therapy, comorbidities or creatinine in first dialysis. There was a significant difference (p <0.05) in mortality in isolated acute renal injury extra renal involvement (RR: 1.55), Critical Care Unit vs Ward (RR: 3.31) and arterial hypotension as cause (RR: 1.79). Patients with chronic dialysis dependence presented higher mortality than those who recovered renal function (50% vs 22%, RR: 2.26). Conclusions: This is the first epidemiological study with follow-up of the population that required renal replacement therapy in Argentina. It is composed of young, severe patients with a high proportion of extra renal organ involvement. Mortality is high and continues beyond the onset of renal replacement therapy, chronic dialysis dependence leads to a worse vital prognosis.
References
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2) Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015;385(9987):2616‐43. doi:10.1016/S0140-6736(15)60126-X.
3) Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;53(6):961‐73. doi:10.1053/j.ajkd.2008.11.034.
4) Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20(1):223-8. doi: 10.1681/ASN.2007080837.
5) Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17(4):1135‐42. doi: 10.1681/ASN.2005060668.
6) Estados Unidos. Renal Data System. USRDS 2007 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States [Internet]. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2007. Disponible en:
7) Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int. 2012;82(5):516‐24. doi:10.1038/ki.2012.208.
8) Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365‐70. doi: 10.1681/ASN.2004090740.
9) Kidney Disease: Improving Global Outcomes (KDIGO), Acute Kidney Injury Work Group. Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1-138.
10) Kane-Gill SL, Sileanu FE, Murugan R, Trietley GS, Handler SM, Kellum JA. Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2015;65(6):860‐9. doi: 10.1053/j.ajkd.2014.10.018.
11) Kirwan CJ, Blunden MJ, Dobbie H, James A, Nedungadi A, Prowle JR. Critically ill patients requiring acute renal replacement therapy are at an increased risk of long-term renal dysfunction, but rarely receive specialist nephrology follow-up. Nephron. 2015;129(3):164‐70. doi:10.1159/000371448.
12) Joannidis M, Metnitz B, Bauer P, Schusters χ² tz N, Moreno R, Druml W, et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35(10):1692‐702. doi:10.1007/s00134-009-1530-4.
13) Romeo FJ, Varela CF, Vulcano N, Pizarro R, Greloni G, Posatini R, et al. Acute kidney injury after cardiac transplantation: foe or common innocent bystander? Transplant Proc. 2018;50(5):1489‐95. doi: 10.1016/j.transproceed.2018.03.106.
14) Salgado G, Landa M, Masevicius D, Gianassi S, San-Román JE, Silva L, et al. Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study. Med Intensiva. 2014;38(5):271-7. doi: 10.1016/j.medin.2013.04.007.
15) Trimarchi H, Nozieres C, Cámpolo Girard V, Lombi F, Smith C, et al. Acute kidney injury in severe sepsis. Medicina (B Aires). 2009;69(3):321-6.
16) Acosta F, Alles A, Alonso C, Arriola M, Carlino MC, Feuli R, et al. Epidemiología de la insuficiencia renal aguda tratada con hemodiálisis: estudio prospectivo multicéntrico de la provincia de Santa Fe. Presentado en el XIII Congreso Argentino de Nefrología (Tucumán, abril 2013).
17) Mehta RL, Burdmann EA, Cerdá J, Feehally J, Finkelstein F, García-García G, et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study. Lancet. 2016; 387(10032):2017-25. doi: 10.1016/S0140-6736(16)30240-9.
18) Santa Fe, Dirección Provincial del Instituto Provincial de Estadística y Censos de la Provincia de Santa Fe. Censo Nacional Población, Hogares y Viviendas 2010. Departamento y total de la provincia de Santa Fe [Internet]. Disponible en:
19) Hsu RK, McCulloch CE, Adams Dudley R, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2012;24(1):37-42. doi: 10.1681/ASN.2012080800.
20) Wald R, McArthur E, Adhikari NK, Bagshaw SM, Burns KEA, Garg AX, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis. 2015;65(6):870-877. doi: 10.1053/j.ajkd.2014.10.017.
21) Siddiqui NF, Coca SG, Devereaux PJ, Jain AK, Li L, Luo J, et al. Secular trends in acute dialysis after elective major surgery, 1995 to 2009. CMAJ. 2012;184(11):1237-1245. doi: 10.1503/cmaj.110895.
22) Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Improved survival in acute kidney injury after cardiac surgery. Am J Kidney Dis. 2007;50(5):703-11. doi: 10.1053/j.ajkd.2007.07.021.
23) Nicoara A, Patel UD, Phillips-Bute BG, Shaw AD, Stafford-Smith M, Milano CA, et al. Mortality trends associated with acute renal failure requiring dialysis after CABG surgery in the United States. Blood Purif. 2009;28(4):359-363. doi: 10.1159/000235856.
24) Hsu RK, McCulloch CE, Heung M, Saran R, Shahinian BV, Pavkov ME, et al. Exploring potential reasons for the temporal trend in dialysis-requiring AKI in the United States. Clin J Am Soc Nephrol. 2016;11(1):14-20. doi: 10.2215/CJN.04520415.
25) Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43-51. doi: 10.2215/CJN.00220605.
26) Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(10):1987-96. doi: 10.1016/j.jacc.2005.11.084.
27) Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17(4):1135-42. doi: 10.1681/ASN.2005060668.
28) Hsu CY, McCulloch CE, Fan D, Ordoñez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int. 2007;72(2):208-212. doi: 10.1038/sj.ki.5002297.
29) Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23. doi: 10.1007/s00134-015-3934-7.
30) Kane-Gill SL, Sileanu FE, Murugan R, Trietley GS, Handler SM, Kellum JA. Risk factors for acute kidney injury in older adults with critical illness: a retrospective cohort study. Am J Kidney Dis. 2015;65(6):860-9. doi: 10.1053/j.ajkd.2014.10.018.
31) Piccinni P, Cruz DN, Gramaticopolo S, Garzotto F, Dal Santo M, Aneloni G, et al. Prospective multicenter study on epidemiology of acute kidney injury in the ICU: a critical care nephrology Italian collaborative effort (NEFROINT). Minerva Anestesiol. 2011;77(11):1072-83.
32) Srisawat N, Sileanu FE, Murugan R, Bellomod R, Calzavacca P, Cartin-Ceba R, et al. Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study. Am J Nephrol. 2015;41(1):81-8. doi: 10.1159/000371748.
33) Harris DG, McCrone MP, Koo G, Weltz AS, Chiu WC, Scalea TM, et al. Epidemiology and outcomes of acute kidney injury in critically ill surgical patients. J Crit Care. 2015;30(1):102-6. doi: 10.1016/j.jcrc.2014.07.028.
34) Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365-70.
35) Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43-51.
36) Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, et al. Renal impairment, and outcomes in heart failure. Systematic review and meta-analysis. J Am Coll Cardiol. 2006;47(10):1987-96.
37) Argentina, Instituto Nacional Central Unico Coordinador de Ablación e Implante. Sistema Nacional de Información de Procuración y Trasplante de la República Argentina [Internet]. Buenos Aires: SINTRA. Disponible en:
38) Argentina, Ministerio del Interior. Registro Nacional de las Personas [Internet]. Buenos Aires: RENAPER. Disponible en:
39) Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442-8. doi: 10.1038/ki.2011.379.
40) Schiffl H, Lang SM, Fischer R. Long-term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: a 10-year prospective cohort study. Clin Kidney J. 2012;5(4):297-302. doi: 10.1093/ckj/sfs070.
41) Sawhney S, Mitchell M, Marks A, Fluck N, Black C. Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review [published correction appears in BMJ Open. 2015;5(1):e006497corr1]. BMJ Open. 2015;5(1):e006497. doi: 10.1136/bmjopen-2014-006497.
42) See EJ, Jayasinghe K, Glassford N, Bailey M, Johnson DW, Polkinghorne KR, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019;95(1):160-72. doi: 10.1016/j.kint.2018.08.036.
43) Coca SG, King JT Jr, Rosenthal RA, Perkal MF, Parikh CR. The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans. Kidney Int. 2010;78(9):926-33. doi: 10.1038/ki.2010.259.
44) Brown JR, Kramer RS, Coca SG, Parikh CR. Duration of acute kidney injury impacts long-term survival after cardiac surgery. Ann Thorac Surg. 2010;90(4):1142-8. doi: 10.1016/j.athoracsur.2010.04.039.
45) Heung M, Steffick DE, Zivin K, Gillespie BW, Banerjee T, Hsu CY, et al. Acute kidney injury recovery pattern and subsequent risk of CKD: an analysis of veterans health administration data. Am J Kidney Dis. 2016;67(5):742-52. doi: 10.1053/j.ajkd.2015.10.019.
46) Gammelager H, Christiansen CF, Johansen MB, Tønnesen E, Jespersen B, Sørensen HT. Three-year risk of cardiovascular disease among intensive care patients with acute kidney injury: a population-based cohort study. Crit Care. 2014;18(5):492. doi: 10.1186/s13054-014-0492-2.
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Published
2020-09-16
How to Cite
1.
Carlino C, Ávila R, Monje L, Mantello C, Taurizano N, Urretavizcaya V, Costantini MS, Ferragut N, Fernández M, Della Rosa G, Josa P, De Prato J, Bragado J, Cuestas M, Alles A. First epidemiological study of acute kidney injury with requirement of renal replacement therapy in Argentina. Intermediate general and renal survival. Rev Nefrol Dial Traspl. [Internet]. 2020Sep.16 [cited 2024Jul.16];40(3):200-9. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/533
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Original Article
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