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Duration of acute kidney injury in critically ill patients

BACKGROUND: Duration of acute kidney injury (AKI) has been recognized a risk factor for adverse outcomes following AKI. We sought to examine the relationship of AKI duration and recurrent AKI with short-term outcomes in critically ill patients who were mechanically ventilated and met criteria for th...

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Autores principales: Federspiel, Christine K., Itenov, Theis S., Mehta, Kala, Hsu, Raymond K., Bestle, Morten H., Liu, Kathleen D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823799/
https://www.ncbi.nlm.nih.gov/pubmed/29473104
http://dx.doi.org/10.1186/s13613-018-0374-x
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author Federspiel, Christine K.
Itenov, Theis S.
Mehta, Kala
Hsu, Raymond K.
Bestle, Morten H.
Liu, Kathleen D.
author_facet Federspiel, Christine K.
Itenov, Theis S.
Mehta, Kala
Hsu, Raymond K.
Bestle, Morten H.
Liu, Kathleen D.
author_sort Federspiel, Christine K.
collection PubMed
description BACKGROUND: Duration of acute kidney injury (AKI) has been recognized a risk factor for adverse outcomes following AKI. We sought to examine the relationship of AKI duration and recurrent AKI with short-term outcomes in critically ill patients who were mechanically ventilated and met criteria for the acute respiratory distress syndrome. METHODS: Participants in the NHLBI ARDS Network SAILS multicenter trial who developed AKI were included in this analysis and divided into groups based on AKI duration. Differences in outcomes were evaluated using t test and Chi-square test. Competing risks regression and Cox regression were used to evaluate factors associated with resolving AKI and recurrent AKI. RESULTS: In total, 238 patients were included in the study. Seventy-seven patients had short duration AKI (1–2 days), 47 medium duration AKI (3–7 days), 87 persistent AKI (> 7 days) and 38 died during their AKI episode. Persistent AKI was associated with worse outcomes including increased ICU length of stay, time on the ventilator and days with cardiovascular failure. We found no clinical differences between patients with short and medium duration AKI, even when accounting for AKI severity and recurrent AKI. Patients with resolving AKI were less likely to have oliguria or moderate/severe ARDS on the day AKI criteria were met. Recurrent AKI was associated with poorer clinical outcomes. No baseline clinical factors were found to predict development of recurrent AKI. CONCLUSIONS: In critically ill patients with sepsis-associated ARDS and AKI, the impact of short and medium duration AKI on clinical outcomes was modest. Persistent and recurrent AKI were both associated with worse clinical outcomes, emphasizing the importance of identifying these patients, who may benefit from novel interventions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0374-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-58237992018-02-28 Duration of acute kidney injury in critically ill patients Federspiel, Christine K. Itenov, Theis S. Mehta, Kala Hsu, Raymond K. Bestle, Morten H. Liu, Kathleen D. Ann Intensive Care Research BACKGROUND: Duration of acute kidney injury (AKI) has been recognized a risk factor for adverse outcomes following AKI. We sought to examine the relationship of AKI duration and recurrent AKI with short-term outcomes in critically ill patients who were mechanically ventilated and met criteria for the acute respiratory distress syndrome. METHODS: Participants in the NHLBI ARDS Network SAILS multicenter trial who developed AKI were included in this analysis and divided into groups based on AKI duration. Differences in outcomes were evaluated using t test and Chi-square test. Competing risks regression and Cox regression were used to evaluate factors associated with resolving AKI and recurrent AKI. RESULTS: In total, 238 patients were included in the study. Seventy-seven patients had short duration AKI (1–2 days), 47 medium duration AKI (3–7 days), 87 persistent AKI (> 7 days) and 38 died during their AKI episode. Persistent AKI was associated with worse outcomes including increased ICU length of stay, time on the ventilator and days with cardiovascular failure. We found no clinical differences between patients with short and medium duration AKI, even when accounting for AKI severity and recurrent AKI. Patients with resolving AKI were less likely to have oliguria or moderate/severe ARDS on the day AKI criteria were met. Recurrent AKI was associated with poorer clinical outcomes. No baseline clinical factors were found to predict development of recurrent AKI. CONCLUSIONS: In critically ill patients with sepsis-associated ARDS and AKI, the impact of short and medium duration AKI on clinical outcomes was modest. Persistent and recurrent AKI were both associated with worse clinical outcomes, emphasizing the importance of identifying these patients, who may benefit from novel interventions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0374-x) contains supplementary material, which is available to authorized users. Springer International Publishing 2018-02-23 /pmc/articles/PMC5823799/ /pubmed/29473104 http://dx.doi.org/10.1186/s13613-018-0374-x Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Federspiel, Christine K.
Itenov, Theis S.
Mehta, Kala
Hsu, Raymond K.
Bestle, Morten H.
Liu, Kathleen D.
Duration of acute kidney injury in critically ill patients
title Duration of acute kidney injury in critically ill patients
title_full Duration of acute kidney injury in critically ill patients
title_fullStr Duration of acute kidney injury in critically ill patients
title_full_unstemmed Duration of acute kidney injury in critically ill patients
title_short Duration of acute kidney injury in critically ill patients
title_sort duration of acute kidney injury in critically ill patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823799/
https://www.ncbi.nlm.nih.gov/pubmed/29473104
http://dx.doi.org/10.1186/s13613-018-0374-x
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