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Survival and renal recovery after acute kidney injury requiring dialysis outside of intensive care units

  • Nephrology - Original Paper
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Abstract

Background

The incidence of acute kidney injury requiring dialysis (AKI-D) is increasing globally and it is usually associated to chronic kidney disease (CKD) and high mortality. Literature is lacking in short- and intermediate-term data on recovery of renal function after acute kidney injury (AKI).

Objectives

The objective was to evaluate the overall survival and renal recovery after an episode of AKI requiring dialysis out of intensive care units (ICUs).

Materials and methods

Retrospective study including patients admitted in two nephrology units along a period of 2 years. Patients admitted to ICUs and renal transplant patients were excluded. Baseline renal function, mortality and glomerular filtration rate (GFR) improvement were evaluated.

Results

151 consecutive adult patients with AKI requiring renal replacement therapy (RRT) were included. Mean age was 70.5 ± 15.2 years, 60.3% were males. Median baseline creatinine (bCr) and baseline GFR (bGFR) were 1.4 mg/dL and 46 mL/min/1.73 m2, respectively. After 1 year of follow-up, we completed the monitoring of 94 patients: 64.9% had died, 10.6% were alive on dialysis and 24.5% were alive without need for RRT. Patients with bGFR > 60 mL/min/1.73 m2 prior to AKI episode had a slower but sustained GFR improvement through the follow-up in comparison with patients with bGFR < 60 mL/min/1.73 m2 whose recovery was incomplete.

Conclusions

Patients with AKI requiring RRT have high short- and intermediate-term mortality and some require maintenance dialysis. Patients with GFR > 60 mL/min/1.73 m2 prior to AKI had a renal recovery closer to the basal renal function than in patients with a previously diminished GFR.

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Abbreviations

ACEi/ARB:

Angiotensin-converting enzyme inhibitor / angiotensin receptor blocker

AKI:

Acute kidney injury

AKI-D:

Acute kidney injury requiring dialysis

AKIN:

Acute kidney injury network

bCr:

Baseline creatinine

bGFR:

Baseline glomerular filtration rate

CKD:

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

ESRD:

End-stage renal disease

GFR:

Glomerular filtration rate

GN:

Glomerulonephritis

HD:

Hemodialysis

ICU:

Intensive care unit

IQR:

Interquartile range

ISN:

International Society of Nephrology

KDIGO:

Kidney disease/improving global outcomes

maxCr:

Maximum creatinine

MDRD-4:

4-Variable standardized—modification of diet in renal disease

minGFR:

Minimum glomerular filtration rate

NSAID:

Nonsteroidal anti-inflammatory drug

pmp:

Per million people

RFR:

Renal functional reserve

RIFLE:

Risk, injury, failure, loss, end-stage kidney disease

RRT:

Renal replacement therapy

sCr:

Serum creatinine

UTO:

Urinary tract obstruction

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Acknowledgments

Dr. González Sanchidrián would like to thank to the Spanish Society of Nephrology for the fellowship for residents in foreign centers in the academic year 2014–2015 to collaborate in the research activity in the International Renal Research Institute of Vicenza (IRRIV), Italy.

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Authors and Affiliations

  1. Division of Nephrology and Dialysis, San Pedro de Alcántara Hospital, University Hospital Complex of Cáceres, Cáceres, Spain

    Silvia González Sanchidrián, Javier L. Deira Lorenzo, Pedro J. Labrador Gómez & Juan R. Gómez-Martino Arroyo

  2. International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Nephrology, Vicenza, Italy

    Silvia González Sanchidrián, M. Jimena Muciño Bermejo, Stefania Aresu, Enrico Tonini, Paolo Armignacco & Claudio Ronco

  3. Intensive Care Unit, Clinica Medica Sur Foundation, Ciudad de México, México

    M. Jimena Muciño Bermejo

  4. Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Cagliari, Italy

    Stefania Aresu

  5. Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

Authors
  1. Silvia González Sanchidrián
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  2. Javier L. Deira Lorenzo
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  3. M. Jimena Muciño Bermejo
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  4. Pedro J. Labrador Gómez
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  7. Enrico Tonini
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  8. Paolo Armignacco
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  9. Claudio Ronco
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Correspondence to Silvia González Sanchidrián.

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González Sanchidrián, S., Deira Lorenzo, J.L., Muciño Bermejo, M.J. et al. Survival and renal recovery after acute kidney injury requiring dialysis outside of intensive care units. Int Urol Nephrol 52, 2367–2377 (2020). https://doi.org/10.1007/s11255-020-02555-2

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  • DOI: https://doi.org/10.1007/s11255-020-02555-2

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