Mortality of acute renal failure requiring hemodialysis in intensive care units

Nadia Fretes Servicio de Nefrología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
Juan Pablo Suárez Servicio de Clínica Médica, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
Estefanía Zambrano León Servicio de Nefrología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
Alexis Marcet Servicio de Nefrología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
María Victoria García Fernández Servicio de Nefrología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
Marina Khoury Epidemiología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
Enrique Dorado Servicio de Nefrología, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina

Keywords: mortality, acute kidney failure, intensive care unit

Abstract

Introduction: Acute renal failure in patients admitted to intensive care units is common and is associated with high mortality. The aim of the study was to identify factors related to mortality in patients with acute renal failure, hospitalized in intensive care units, who required renal replacement therapy. Methods: We retrospectively identified 3,732 patients admitted to intensive care units; 2.7% had acute renal failure requiring replacement therapy for renal function. Patients with a history of chronic kidney disease with a glomerular filtration rate of less than 15 mL/m or on chronic dialysis were excluded. Results: 97 cases were analyzed, 55% women, median age: 74 years (interquartile range: 68-78). The most frequent reasons for acute renal failure were sepsis (41.2%) and ischemic acute tubular necrosis (36.1%); 22.7% were diabetic. The median APACHE II score was 23 (interquartile range: 19-28). 75.3% required mechanical ventilation and 81.4%, inotropic drugs. Median time of hospitalization in intensive care units was 8 days (interquartile range: 4-11) and the mortality rate was 58.76%. In the individual analysis, mortality was associated with mechanical ventilation (p<0.0001), the use of inotropic drugs (p<0.0001) and a history of chronic kidney disease (p=0.008), but no association was found with sex, age, APACHE II score, diabetes, or other cardiovascular risk factors. Multivariate model of factors associated with mortality: mechanical ventilation (Odds Ratio=14.16; p=0.003), inotropic drugs (Odds Ratio=8.73; p=0.07) and chronic kidney disease (Odds Ratio=0.27; p=0.020). Conclusions: Patients with acute renal failure who required renal replacement therapy and were admitted to intensive care units presented high mortality. The requirement for mechanical ventilation was associated with higher mortality, as was the use of inotropic drugs, although it did not reach statistical significance in the multivariate analysis. A history of chronic kidney disease was associated with lower mortality.

References

1) National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl. 1):S1-266.

2) 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.

3) Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med. 2001;29(10):1910-5. doi: 10.1097/00003246-200110000-00010.

4) Samimagham HR, Kheirkhah S, Haghighi A, Najmi Z. Acute kidney injury in intensive care unit: incidence, risk factors and mortality rate. Saudi J Kidney Dis Transpl. 2011;22(3):464-70.

5) KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1-138.

6) Ronco C, Kellum JA, Bellomo R, House AA. Potential interventions in sepsis-related acute kidney injury. Clin J Am Soc Nephrol. 2008;3(2):531-44. doi: 10.2215/CJN.03830907.

7) Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813-8. doi: 10.1001/jama.294.7.813.

8) Lines SW, Cherukuri A, Murdoch SD, Bellamy MC, Lewington AJ. The outcomes of critically ill patients with acute kidney injury receiving renal replacement therapy. Int J Artif Organs. 2011;34(1):2-9. doi: 10.5301/ijao.2011.6312.

9) Rennie TJ, Patton A, Dreischulte T, Bell S. Incidence and outcomes of acute kidney injury requiring renal replacement therapy: a retrospective cohort study. Nephron. 2016;133(4):239-46. doi: 10.1159/000447544.

10) Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int. 2011;79(12):1361-9. doi: 10.1038/ki.2011.42.

11) Mehta RL, Bouchard J, Soroko SB, Ikizler TA, Paganini EP, Chertow GM, et al.; Program to Improve Care in Acute Renal Disease (PICARD) Study Group. Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease. Intensive Care Med. 2011;37(2):241-8. doi: 10.1007/s00134-010-2089-9.

12) Prowle JR, Molan MP, Hornsey E, Bellomo R. Measurement of renal blood flow by phase-contrast magnetic resonance imaging during septic acute kidney injury: a pilot investigation. Crit Care Med. 2012;40(6):1768-76. doi: 10.1097/CCM.0b013e318246bd85.

13) Langenberg C, Bellomo R, May C, Wan L, Egi M, Morgera S. Renal blood flow in sepsis. Crit Care. 2005;9(4):R363-74. doi: 10.1186/cc3540.

14) Langenberg C, Wan L, Egi M, May CN, Bellomo R. Renal blood flow in experimental septic acute renal failure. Kidney Int. 2006;69(11):1996-2002. doi: 10.1038/sj.ki.5000440.

15) Gomez H, Ince C, De Backer D, Pickkers P, Payen D, Hotchkiss J, et al. A unified theory of sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury. Shock. 2014;41(1):3-11. doi: 10.1097/SHK.0000000000000052.

16) Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ. 2019;364: k4891. doi: 10.1136/bmj.k4891.

17) Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al.; Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol. 2007;2(3):431-9. doi: 10.2215/CJN.03681106.

18) Zarjou A, Agarwal A. Sepsis and acute kidney injury. J Am Soc Nephrol. 2011;22(6):999-1006. doi: 10.1681/ASN.2010050484.

19) Elseviers MM, Lins RL, Van der Niepen P, Hoste E, Malbrain ML, Damas P, et al. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care. 2010;14(6):R221. doi: 10.1186/cc9355.

20) Duran PA, Concepción LA. Survival after acute kidney injury requiring dialysis: long-term follow up. Hemodial Int. 2014;18(Suppl. 1):S1-6. doi: 10.1111/hdi.12216.

21) Zhi DY, Lin J, Zhuang HZ, Dong L, Ji XJ, Guo DC, et al. Acute kidney injury in critically ill patients with sepsis: clinical characteristics and outcomes. J Invest Surg. 2019;32(8):689-96. doi: 10.1080/08941939.2018.1453891.

22) Ng KP, Chanouzas D, Fallouh B, Baharani J. Short and long-term outcome of patients with severe acute kidney injury requiring renal replacement therapy. QJM. 2012;105(1):33-9. doi: 10.1093/qjmed/hcr133.

23) Vesconi S, Cruz DN, Fumagalli R, Kindgen-Milles D, Monti G, Marinho A, et al.; DOse REsponse Multicentre International collaborative Initiative (DO-RE-MI Study Group). Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury. Crit Care. 2009;13(2):R57. doi: 10.1186/cc7784.

Published

2021-03-25

How to Cite

Fretes N, Suárez JP, Zambrano León E, Marcet A, García Fernández MV, Khoury M, Dorado E. Mortality of acute renal failure requiring hemodialysis in intensive care units. Rev Nefrol Dial Traspl. [Internet]. 2021Mar.25 [cited 2024Dec.22];41(1):30-5. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/614

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Vol. 41 No. 1 (2121): Jan.-March

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Original Article

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