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Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study

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An Erratum to this article was published on 24 January 2013

Abstract

Purpose

We aimed to determine the incidence, risk factors and outcome of acute kidney injury (AKI) in Finnish ICUs.

Methods

This prospective, observational, multi-centre study comprised adult emergency admissions and elective patients whose stay exceeded 24 h during a 5-month period in 17 Finnish ICUs. We defined AKI first by the Acute Kidney Injury Network (AKIN) criteria supplemented with a baseline creatinine and second with the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We screened the patients’ AKI status and risk factors for up to 5 days.

Results

We included 2,901 patients. The incidence (95 % confidence interval) of AKI was 39.3 % (37.5–41.1 %). The incidence was 17.2 % (15.8–18.6 %) for stage 1, 8.0 % (7.0–9.0 %) for stage 2 and 14.1 % (12.8–15.4 %) for stage 3 AKI. Of the 2,901 patients 296 [10.2 % (9.1–11.3 %)] received renal replacement therapy. We received an identical classification with the new KDIGO criteria. The population-based incidence (95 % CI) of ICU-treated AKI was 746 (717–774) per million population per year (reference population: 3,671,143, i.e. 85 % of the Finnish adult population). In logistic regression, pre-ICU hypovolaemia, diuretics, colloids and chronic kidney disease were independent risk factors for AKI. Hospital mortality (95 % CI) for AKI patients was 25.6 % (23.0–28.2 %) and the 90-day mortality for AKI patients was 33.7 % (30.9–36.5 %). All AKIN stages were independently associated with 90-day mortality.

Conclusions

The incidence of AKI in the critically ill in Finland was comparable to previous large multi-centre ICU studies. Hospital mortality (26 %) in AKI patients appeared comparable to or lower than in other studies.

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Acknowledgments

We thank Tieto Healthcare and Welfare Ltd for database management. We received Clinical Research funding (EVO) TYH 2010109/2011210 and T102010070 from Helsinki University Hospital and grants from the Finnish Society of Intensive Care, the Academy of Finland and the Juselius Foundation. SN has received a grant from the Finnish Society of Anaesthesiologists.

Author information

Authors and Affiliations

  1. Division of Anaesthesia and Intensive Care Medicine Department of Surgery, Intensive Care Units, Helsinki University Central Hospital, Box 340, 00029 HUS, Helsinki, Finland

    Sara Nisula, Kirsi-Maija Kaukonen, Suvi T. Vaara, Anna-Maija Korhonen, Raili Suojaranta-Ylinen & Ville Pettilä

  2. Department of Anesthesia and Intensive Care Medicine, Lapland Central Hospital, Rovaniemi, Finland

    Meri Poukkanen

  3. Department of Intensive Care, North Karelia Central Hospital, Joensuu, Finland

    Sari Karlsson & Matti Reinikainen

  4. Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland

    Sari Karlsson, Jyrki Tenhunen & Anne Kuitunen

  5. Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland

    Mikko Haapio

  6. Department of Anesthesia and Intensive Care Medicine, Turku University Hospital, Turku, Finland

    Outi Inkinen

  7. Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland

    Ilkka Parviainen & Esko Ruokonen

  8. Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland

    Jouko J. Laurila & Tero Ala-Kokko

  9. Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland

    Ville Pettilä

Authors
  1. Sara Nisula
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  2. Kirsi-Maija Kaukonen
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  3. Suvi T. Vaara
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  6. Sari Karlsson
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  16. Anne Kuitunen
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  17. Ville Pettilä
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Consortia

The FINNAKI Study Group

Corresponding author

Correspondence to Sara Nisula.

Additional information

Members of the FINNAKI Study Group are listed in the Appendix.

The FINNAKI study group

The FINNAKI study group

Central Finland Central Hospital: Raili Laru-Sompa, Anni Pulkkinen, Minna Saarelainen, Mikko Reilama, Sinikka Tolmunen, Ulla Rantalainen, Marja Miettinen. East Savo Central Hospital: Markku Suvela, Katrine Pesola, Pekka Saastamoinen, Sirpa Kauppinen. Helsinki University Central Hospital: Ville Pettilä, Kirsi-Maija Kaukonen, Anna-Maija Korhonen, Sara Nisula, Suvi Vaara, Raili Suojaranta-Ylinen, Leena Mildh, Mikko Haapio, Laura Nurminen, Sari Sutinen, Leena Pettilä, Helinä Laitinen, Heidi Syrjä, Kirsi Henttonen, Elina Lappi, Hillevi Boman. Jorvi Central Hospital: Tero Varpula, Päivi Porkka, Mirka Sivula Mira Rahkonen, Anne Tsurkka, Taina Nieminen, Niina Prittinen. Kanta-Häme Central Hospital: Ari Alaspää, Ville Salanto, Hanna Juntunen, Teija Sanisalo. Kuopio University Hospital: Ilkka Parviainen, Ari Uusaro, Esko Ruokonen, Stepani Bendel, Niina Rissanen, Maarit Lång, Sari Rahikainen, Saija Rissanen, Merja Ahonen, Elina Halonen, Eija Vaskelainen. Lapland Central Hospital: Meri Poukkanen, Esa Lintula, Sirpa Suominen. Länsi Pohja Central Hospital: Jorma Heikkinen, Timo Lavander, Kirsi Heinonen, Anne-Mari Juopperi. Middle Ostrobothnia Central Hospital: Tadeusz Kaminski, Fiia Gäddnäs, Tuija Kuusela, Jane Roiko. North Karelia Central Hospital: Sari Karlsson, Matti Reinikainen, Tero Surakka, Helena Jyrkönen, Tanja Eiserbeck, Jaana Kallinen. Satakunta Hospital District: Vesa Lund, Päivi Tuominen, Pauliina Perkola, Riikka Tuominen, Marika Hietaranta, Satu Johansson. South Karelia Central Hospital: Seppo Hovilehto, Anne Kirsi, Pekka Tiainen, Tuija Myllärinen, Pirjo Leino, Anne Toropainen. Tampere University Hospital: Anne Kuitunen, Ilona Leppänen, Markus Levoranta, Sanna Hoppu, Jukka Sauranen, Jyrki Tenhunen, Atte Kukkurainen, Samuli Kortelainen, Simo Varila. Turku University Hospital: Outi Inkinen, Niina Koivuviita, Jutta Kotamäki, Anu Laine. Oulu University Hospital: Tero Ala-Kokko, Jouko Laurila, Sinikka Sälkiö. Vaasa Central Hospital: Simo-Pekka Koivisto, Raku Hautamäki, Maria Skinnar.

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Nisula, S., Kaukonen, KM., Vaara, S.T. et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med 39, 420–428 (2013). https://doi.org/10.1007/s00134-012-2796-5

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