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Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy
BACKGROUND: Perioperative acute kidney injury (AKI) is associated with multiple postoperative complications leading to prolonged hospital stay and higher costs. AKI requiring continuous renal replacement therapy (CRRT) after surgery has an incidence of 2–6% and mortality approximates 40–60%. Previou...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670067/ https://www.ncbi.nlm.nih.gov/pubmed/34903294 http://dx.doi.org/10.1186/s13741-021-00227-y |
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author | Uusalo, Panu Hellman, Tapio Järvisalo, Mikko J. |
author_facet | Uusalo, Panu Hellman, Tapio Järvisalo, Mikko J. |
author_sort | Uusalo, Panu |
collection | PubMed |
description | BACKGROUND: Perioperative acute kidney injury (AKI) is associated with multiple postoperative complications leading to prolonged hospital stay and higher costs. AKI requiring continuous renal replacement therapy (CRRT) after surgery has an incidence of 2–6% and mortality approximates 40–60%. Previous studies examining mortality in perioperative AKI patients managed with CRRT have concentrated on cardiac surgery patients and there are very limited data on broad surgical patient populations requiring CRRT. We examined long-term mortality and factors associated with poor outcome in a broad surgical population requiring CRRT for perioperative AKI during a 10-year period. METHODS: Surgical patients admitted to the intensive care unit (ICU) of academic tertiary hospital requiring CRRT between years 2010–2019 were included. CRRT was performed using regional citrate-calcium-anticoagulation. Extracted data included patient demographics, comorbidities, and clinical parameters at ICU admission and at the initiation of CRRT. Creatinine and estimated glomerular filtration rate (eGFR) were measured at 1 year after ICU admission. RESULTS: A total of 157 patients were included in the study. ICU mortality was 42.7%, 90-day mortality 58.0% and 1-year mortality 62.4%. Blood lactate at ICU admission and CRRT initiation were independently associated with mortality in the multivariate models. Patients with lactate > 4 mmol/l had higher mortality than patients with normal lactate (77% vs. 21%) (p < 0.001). Creatinine (p = 0.004) and eGFR (p < 0.001) remained significantly altered at 1 year of follow-up compared to baseline. CONCLUSIONS: Patients undergoing surgery and requiring perioperative CRRT in the ICU have a high risk of mortality. Mortality appears to be independently associated with lactate levels. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13741-021-00227-y. |
format | Online Article Text |
id | pubmed-8670067 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-86700672021-12-15 Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy Uusalo, Panu Hellman, Tapio Järvisalo, Mikko J. Perioper Med (Lond) Research BACKGROUND: Perioperative acute kidney injury (AKI) is associated with multiple postoperative complications leading to prolonged hospital stay and higher costs. AKI requiring continuous renal replacement therapy (CRRT) after surgery has an incidence of 2–6% and mortality approximates 40–60%. Previous studies examining mortality in perioperative AKI patients managed with CRRT have concentrated on cardiac surgery patients and there are very limited data on broad surgical patient populations requiring CRRT. We examined long-term mortality and factors associated with poor outcome in a broad surgical population requiring CRRT for perioperative AKI during a 10-year period. METHODS: Surgical patients admitted to the intensive care unit (ICU) of academic tertiary hospital requiring CRRT between years 2010–2019 were included. CRRT was performed using regional citrate-calcium-anticoagulation. Extracted data included patient demographics, comorbidities, and clinical parameters at ICU admission and at the initiation of CRRT. Creatinine and estimated glomerular filtration rate (eGFR) were measured at 1 year after ICU admission. RESULTS: A total of 157 patients were included in the study. ICU mortality was 42.7%, 90-day mortality 58.0% and 1-year mortality 62.4%. Blood lactate at ICU admission and CRRT initiation were independently associated with mortality in the multivariate models. Patients with lactate > 4 mmol/l had higher mortality than patients with normal lactate (77% vs. 21%) (p < 0.001). Creatinine (p = 0.004) and eGFR (p < 0.001) remained significantly altered at 1 year of follow-up compared to baseline. CONCLUSIONS: Patients undergoing surgery and requiring perioperative CRRT in the ICU have a high risk of mortality. Mortality appears to be independently associated with lactate levels. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13741-021-00227-y. BioMed Central 2021-12-14 /pmc/articles/PMC8670067/ /pubmed/34903294 http://dx.doi.org/10.1186/s13741-021-00227-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Uusalo, Panu Hellman, Tapio Järvisalo, Mikko J. Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy |
title | Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy |
title_full | Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy |
title_fullStr | Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy |
title_full_unstemmed | Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy |
title_short | Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy |
title_sort | mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670067/ https://www.ncbi.nlm.nih.gov/pubmed/34903294 http://dx.doi.org/10.1186/s13741-021-00227-y |
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