Determinants of renal function at hospital discharge of patients treated with renal replacement therapy in the intensive care unit

• Published in: Journal of critical care Vol. 28; no. 2; pp. 126 - 132
• Main Authors: Fortrie, Gijs, MSc, Stads, Susanne, MD, de Geus, Hilde R.H., MD, Groeneveld, A.B. Johan, MD, PhD, FCCP, FCCM, Zietse, Robert, MD, PhD, Betjes, Michiel G.H., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2013; Elsevier Limited
• Subjects: Acute kidney injury; Acute Kidney Injury - epidemiology; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Acute renal failure; Adult; Age Factors; Aged; Chronic kidney disease; Creatinine - blood; Critical Care; Critical ill; Dialysis; Female; Glomerular Filtration Rate; Health Status Indicators; Hemodialysis; Hospitals; Humans; Intensive Care Units - statistics & numerical data; Kidney diseases; Kidney Function Tests; Male; Middle Aged; Mortality; Patient Discharge - statistics & numerical data; Renal Insufficiency, Chronic - epidemiology; Renal recovery; Renal replacement therapy; Renal Replacement Therapy - statistics & numerical data; Retrospective Studies; Risk Factors; Socioeconomic Factors; Netherlands; Acute kidney injury; Dialysis; Chronic kidney disease; Renal replacement therapy; Critical ill; Acute renal failure; Renal recovery
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2012.10.013

Abstract Purpose Identification of risk factors for impaired renal function at hospital discharge in critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT). Methods A single-center retrospective cohort study was performed evaluating demographic and clinical parameters as potential risk factors for a modest to severely impaired renal function at hospital discharge in patients with AKI requiring RRT in the intensive care unit. Results Of the 353 patients in our cohort, 90 (25.5%) patients had pre-existing chronic kidney disease (CKD). An estimated glomerular filtration rate (eGFR) ≤ 60 mL min − 1 1.73 m − 2 at hospital discharge occurred in 64.0% of which 63.7% without known renal impairment before hospital admission and 8.2% of all cases left the hospital dialysis-dependent. Multivariable logistic regression showed that age (OR = 1.051, P < .001), serum creatinine concentration at start of RRT (OR = 1.004, P < .001) and administration of iodine-containing contrast fluid (OR = 0.830, P = .045) were associated with an eGFR ≤ 60 mL min − 1 1.73 m − 2 . Furthermore, a medical history of CKD (OR = 5.865, P < .001) was associated with dialysis dependence. Conclusions Elderly and patients with pre-existing CKD are at a high risk for modest to severely impaired renal function at hospital discharge after AKI requiring RRT.