Skip to main content

Long-term outcomes in acute kidney injury patients who underwent continuous renal replacement therapy: a single-center experience

Clinical and Experimental Nephrology volume 22, pages 1411–1419 (2018)Cite this article

Abstract

Introduction

Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is the most severe form of AKI associated with poor short- and long-term patient outcomes. The aim of this study was to evaluate the variables associated with long-term patient survival in our clinic.

Methods

This was a single-center retrospective study with AKI survivors who received CRRT from March 2011 to February 2015. During the study period, all consecutive AKI survivors who underwent CRRT were included. Patients on maintenance dialysis prior to CRRT were excluded. Data were collected by reviewing the patients’ medical charts. Long-term follow-up data were gathered through February 2018.

Results

A total of 430 patients were included, and 62.8% of the patients were male. The mean age of the patients was 63.4 ± 14.6 years. The mean serum creatinine level at the time of CRRT initiation was 3.5 ± 2.5 mg/dL. At the time of discharge, the mean eGFR and serum creatinine levels were 58.4 ± 46.7 and 1.7 ± 1.6 mg/dL, respectively. After 3 years, 44.9% of the patients had survived. When we investigated the factors associated with long-term patient mortality, a longer stay in the ICU [OR 1.034 (1.016–1.053), p < 0.001], a history of cancer [OR 3.830 (1.037–3.308), p = 0.037], a prolonged prothrombin time [OR 1.852 (1.037–3.308), p = 0.037] and a lower eGFR at the time of discharge [OR 0.988 (0.982–0.995), p = 0.001] were independently associated with long-term patient mortality.

Conclusion

Our study demonstrates that long-term mortality after CRRT is associated with longer ICU stays and lower eGFRs at the time of hospital discharge. Our data imply the importance of renal recovery for long-term survival of AKI patients treated with CRRT.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Doyle JF, Forni LG. Acute kidney injury: short-term and long-term effects. Crit Care. 2016;20(1):188. https://doi.org/10.1186/s13054-016-1353-y.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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. https://doi.org/10.1038/ki.2011.379.

    Article  PubMed  Google Scholar 

  3. Vanmassenhove J, Vanholder R, Lameire N. Points of concern in post acute kidney injury management. Nephron. 2017. https://doi.org/10.1159/000484146.

    Article  PubMed  Google Scholar 

  4. Rhee H, Jang GS, Han M, Park IS, Kim IY, Song SH, et al. The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience. BMC Nephrol. 2017;18(1):332. https://doi.org/10.1186/s12882-017-0746-8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ronco C, Ricci Z, De Backer D, Kellum JA, Taccone FS, Joannidis M, et al. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care. 2015;19:146. https://doi.org/10.1186/s13054-015-0850-8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.

    CAS  Article  Google Scholar 

  7. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754–8.

    CAS  Article  Google Scholar 

  8. Rhee H, Jang KS, Shin MJ, Lee JW, Kim IY, Song SH, et al. Use of multifrequency bioimpedance analysis in male patients with acute kidney injury who are undergoing continuous veno-venous hemodiafiltration. PLoS One. 2015;10(7):e0133199. https://doi.org/10.1371/journal.pone.0133199.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. Ahlstrom A, Tallgren M, Peltonen S, Rasanen P, Pettila V. Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med. 2005;31(9):1222–8. https://doi.org/10.1007/s00134-005-2681-6.

    Article  PubMed  Google Scholar 

  10. Korkeila M, Ruokonen E, Takala J. Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med. 2000;26(12):1824–31.

    CAS  Article  Google Scholar 

  11. Van Berendoncks AM, Elseviers MM, Lins RL, Group SS. Outcome of acute kidney injury with different treatment options: long-term follow-up. Clin J Am Soc Nephrol. 2010;5(10):1755–62. https://doi.org/10.2215/CJN.00770110.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schiffl H, Fischer R. Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant. 2008;23(7):2235–41. https://doi.org/10.1093/ndt/gfn182.

    Article  PubMed  Google Scholar 

  13. Liano F, Felipe C, Tenorio MT, Rivera M, Abraira V, Saez-de-Urturi JM, et al. Long-term outcome of acute tubular necrosis: a contribution to its natural history. Kidney Int. 2007;71(7):679–86. https://doi.org/10.1038/sj.ki.5002086.

    CAS  Article  PubMed  Google Scholar 

  14. Morgera S, Kraft AK, Siebert G, Luft FC, Neumayer HH. Long-term outcomes in acute renal failure patients treated with continuous renal replacement therapies. Am J Kidney Dis. 2002;40(2):275–9. https://doi.org/10.1053/ajkd.2002.34505.

    Article  PubMed  Google Scholar 

  15. Rhee H, Jang KS, Park JM, Kang JS, Hwang NK, Kim IY, et al. Short- and long-term mortality rates of elderly acute kidney injury patients who underwent continuous renal replacement therapy. PLoS One. 2016;11(11):e0167067. https://doi.org/10.1371/journal.pone.0167067.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. Basile DP, Bonventre JV, Mehta R, Nangaku M, Unwin R, Rosner MH, et al. Progression after AKI: understanding maladaptive repair processes to predict and identify therapeutic treatments. J Am Soc Nephrol. 2016;27(3):687–97. https://doi.org/10.1681/ASN.2015030309.

    CAS  Article  PubMed  Google Scholar 

  17. Sawhney S, Marks A, Fluck N, Levin A, McLernon D, Prescott G, et al. Post-discharge kidney function is associated with subsequent ten-year renal progression risk among survivors of acute kidney injury. Kidney Int. 2017;92(2):440–52. https://doi.org/10.1016/j.kint.2017.02.019.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105–22. https://doi.org/10.1007/s00134-017-4867-0.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bucaloiu ID, Kirchner HL, Norfolk ER, Hartle JE 2nd, Perkins RM. Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury. Kidney Int. 2012;81(5):477 – 85. https://doi.org/10.1038/ki.2011.405.

    Article  PubMed  Google Scholar 

  20. van Kuijk JP, Flu WJ, Chonchol M, Hoeks SE, Winkel TA, Verhagen HJ, et al. Temporary perioperative decline of renal function is an independent predictor for chronic kidney disease. Clin J Am Soc Nephrol. 2010;5(7):1198 – 204. https://doi.org/10.2215/CJN.00020110.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wu VC, Huang TM, Lai CF, Shiao CC, Lin YF, Chu TS, et al. Acute-on-chronic kidney injury at hospital discharge is associated with long-term dialysis and mortality. Kidney Int. 2011;80(11):1222–30. https://doi.org/10.1038/ki.2011.259.

    Article  PubMed  Google Scholar 

  22. Jones J, Holmen J, De Graauw J, Jovanovich A, Thornton S, Chonchol M. Association of complete recovery from acute kidney injury with incident CKD stage 3 and all-cause mortality. Am J Kidney Dis. 2012;60(3):402–8. https://doi.org/10.1053/j.ajkd.2012.03.014.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pannu N, James M, Hemmelgarn B, Klarenbach S, Alberta Kidney Disease N. Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol. 2013;8(2):194–202. https://doi.org/10.2215/CJN.06480612.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Biomedical Institute of Pusan National University Hospital. We sincerely thank Dr. Keun Hyeun Lee at the Hemin Korean Traditional Medical Clinic for analyzing the data.

Author information

Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea

    Harin Rhee, Miyeun Han, Inseong Park, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak & Sang Heon Song

  2. Division of Nephrology, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro179, Seo-gu, Pusan, 602-739, Republic of Korea

    Harin Rhee, Miyeun Han, Inseong Park, Eun Young Seong, Ihm Soo Kwak & Sang Heon Song

  3. Department of Nursing, Pusan National University Hospital, Pusan, Republic of Korea

    Gum Sook Jang & Yeo Jin An

Authors
  1. Harin Rhee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gum Sook Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yeo Jin An
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miyeun Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Inseong Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Il Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eun Young Seong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dong Won Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Soo Bong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ihm Soo Kwak
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sang Heon Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang Heon Song.

Ethics declarations

Conflict of interest

None of the authors have declared any competing interest.

Human and animal rights

All procedures in studies involving human participants were performed in accordance with the ethical standards of the appropriate institutional and/or national review board (Pusan National University IRB Committee [1801-010-063]) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived by the IRB due to the retrospective nature of the analysis that used information contained in medical charts and records, which were anonymized.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rhee, H., Jang, G.S., An, Y.J. et al. Long-term outcomes in acute kidney injury patients who underwent continuous renal replacement therapy: a single-center experience. Clin Exp Nephrol 22, 1411–1419 (2018). https://doi.org/10.1007/s10157-018-1595-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-018-1595-x

Keywords

  • Acute kidney injury
  • Continuous renal replacement therapy
  • Long-term outcome