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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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