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Kritik hastalarda diyaliz gerektiren akut böbrek yetmezliğinin klinik özellikleri ve kısa dönemli sonuçları

Year 2020, Volume: 4 Issue: 7, 558 - 561, 01.07.2020
https://doi.org/10.28982/josam.749996

Abstract

Amaç: Diyaliz gerektiren akut böbrek hasarı yoğun bakım ünitelerinde yüksek mortalite ve diyalize bağımlı kronik böbrek hastalığı gibi olumsuz sonuçları ile ilişkilidir. Bu retrospektif çalışma günümüz yoğun bakım pratiğinde diyaliz gerektiren akut böbrek hasarının klinik özelliklerini ve renal replasman tedavi yöntemlerini tanımlamayı amaçlamıştır.
Yöntemler: Bu retrospektif kohort çalışma, bir üniversite hastanesinin 20 yataklı üçüncü basamak yoğun bakım ünitesinde 2011-2017 arasında gerçekleştirilmiştir. Toplamda, renal replasman tedavisi uygulanan 145 diyaliz gerektiren akut böbrek hasarı hastası tanımlanmıştır. Diyaliz gerektiren akut böbrek hasarı hastalarının hastane kayıtları demografi, tıbbi öykü, klinik özellikler, renal replasman tedavisi detayları ve ısa dönemli sonuçlar için retrospektif olarak analiz edilmiştir.
Bulgular: İncelenen 1689 hastanın 145’inde diyaliz gerektiren akut böbrek hasarı mevcuttu. Dahil edilen hastaların ortanca yaşı 73 idi. septik etiyoloji, diyaliz gerektiren akut böbrek hasarı gelişiminde en sık şüphelenilen nedendi. Elli iki hasta (%35,9) sürekli renal replasman tedavisi hastaya uygulanmışken 93 hastaya (%64,1) aralıklı hemodiyaliz uygulanmıştır. Sürekli renal replasman tedavisi uygulanan hastalarda mekanik ventilasyon ve inotrop desteği daha sık kullanılmıştır (P=0,03). Toplamda, hastane içi mortalite oranı %73,1 iken taburculukta diyaliz bağımlı kronik böbrek hastalığı oranı %6,2 idi. mortalite oranı sürekli renal replasman tedavisi uygulanan hastalarda anlamlı olarak daha yüksekti (%84,6’ya karşılık %66,7, P=0,019).
Sonuç: Çalışmamızın bulguları yoğun bakım hastalarında diyaliz gerektiren akut böbrek hasarının en önemli nedeninin sepsis olduğunu göstermektedir. Diyaliz gerektiren akut böbrek hasarı yaşlı hastalarda daha fazla görülmüştür ve kısa dönemli mortalite riskinde artış ile ilişkilidir. 

References

  • 1. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411-23.
  • 2. Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA. 2009;302:1179-85.
  • 3. Kılıç A, Şişik A. A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplast. J Surg Med. 2020;4(5):331-3. DOI: 10.28982/josam.737762.
  • 4. Rimes-Stigare C, Frumento P, Bottai M, Mårtensson J, Martling CR, Walther SM, et al. Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill; a Swedish multi-centre cohort study. Crit Care. 2015;19:221.
  • 5. Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007;35:1837-43.
  • 6. de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26(7):915-21.
  • 7. Kohli HS, Bhat A, Jairam A, Aravindan AN, Sud K, Jha V, et al. Predictors of mortality in acute renal failure in a developing country: a prospective study. Ren Fail. 2007;29:463-9.
  • 8. Sakhuja A, Kumar G, Gupta S, Mittal T, Taneja A, Nanchal RS. Acute kidney injury requiring dialysis in severe sepsis. Am J Respir Crit Care Med. 2015;192:951-7.
  • 9. Pickkers P, Ostermann M, Joannidis M, Zarbock A, Hoste E, Bellomo R, et al. The intensive care medicine agenda on acute kidney injury. Intensive Care Med. 2017;43:1198-209.
  • 10. Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, et al. Dialysis-requiring acute kidney injury in Denmark 2000-2012: time trends of incidence and prevalence of risk factors - a nationwide study. PLoS One. 2016;11:e0148809.
  • 11. Kidney Disease: Improving Global Outcomes (KDIGO) AKI Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;17:S1-138.
  • 12. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
  • 13. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009;113:S1-130.
  • 14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-83.
  • 15. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247-54.
  • 16. Wilson FP, Yang W, Feldman HI. Predictors of death and dialysis in severe AKI: the UPHS-AKI cohort. Clin J Am Soc Nephrol. 2013;8:527-37.
  • 17. Gallagher M, Cass A, Bellomo R, Finfer S, Gattas D, Lee J, et al. Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med. 2014;11:e1001601.
  • 18. Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, et al. Trends in one-year outcomes of dialysis-requiring acute kidney injury in Denmark 2005-2012: a population-based nationwide study. PLoS One. 2016;11:e0159944.
  • 19. Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17:1135-42.
  • 20. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2013;24:37-42.
  • 21. Wald R, McArthur E, Adhikari NK, Bagshaw SM, Burns KE, Garg AX, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis. 2015;65:870-7.
  • 22. See EJ, Jayasinghe K, Glassford N, Bailey M, Johnson DW, Polkinghorne KR, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019;95:160-72.
  • 23. Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014;371:58-66.
  • 24. Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20:223-8.
  • 25. Gammelager H, Christiansen CF, Johansen MB, Tønnesen E, Jespersen B, Sørensen HT. Five-year risk of end-stage renal disease among intensive care patients surviving dialysis-requiring acute kidney injury: a nationwide cohort study. Crit Care. 2013;17:R145.
  • 26. Harel Z, Bell CM, Dixon SN, McArthur E, James MT, Garg AX, et al. Predictors of progression to chronic dialysis in survivors of severe acute kidney injury: a competing risk study. BMC Nephrol. 2014;15:114.
  • 27. Rauf AA, Long KH, Gajic O, Anderson SS, Swaminathan L, Albright RC. Intermittent hemodialysis versus continuous renal replacement therapy for acute renal failure in the intensive care unit: an observational outcomes analysis. J Intensive Care Med. 2008;23:195-203.
  • 28. Kwizera A, Tumukunde J, Ssemogerere L, Ayebale E, Agaba P, Yakubu J, et al. Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an African intensive care unit. Biomed Res Int. 2016;2016:2015251.
  • 29. Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007;3:CD003773.
  • 30. Nash DM, Przech S, Wald R, O'Reilly D. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017;41:138-44.
  • 31. Ronco C, Ricci Z, De Backer D, Kellum JA, Taccone FS, Joannidis M, et al. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care. 2015;19:146.
  • 32. Vanholder R, Van Biesen W, Hoste E, Lameire N. Pro/con debate: continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the finish? Crit Care. 2011;15:204.
  • 33. Gibney RT. Continous renal replacement therapy and intermittent hemodialysis in acute kidney injury: equivalent or complementary? J Thorac Dis. 2016;8:2397-9.
  • 34. Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, et al. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care. 2010;14:R82.

Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients

Year 2020, Volume: 4 Issue: 7, 558 - 561, 01.07.2020
https://doi.org/10.28982/josam.749996

Abstract

Aim: Dialysis-requiring acute kidney injury (D-AKI) in intensive care unit (ICU) continues to be associated with adverse outcomes of high mortality and dialysis-dependent chronic kidney disease (CKD). This retrospective study aimed to identify clinical characteristics of dialysis-requiring AKI and renal replacement therapy (RRT) which replaces the normal blood-filtering function of the kidneys in current ICU practice.
Methods: This retrospective cohort study was conducted in a 20-bed, third level ICU of a University Hospital between 2011 and 2017. In total, 145 D-AKI patients who underwent RRT were identified. Hospital records of patients with D-AKI were retrospectively analyzed for demographics, medical history, clinical characteristics, details of RRT modality, and short-term outcome.
Results: Of the 1689 patients investigated, 145 had D-AKI. The median age of the patients included in the study was 73 years. Septic etiology was the most common suspected cause for D-AKI development. Fifty-two patients (35.9%) underwent continuous RRT (CRRT) while intermittent hemodialysis was used in 93 patients (64.1%). Mechanical ventilation and inotropic support were more commonly used in CRRT patients than IHD patients (P=0.03). In total, in-hospital mortality rate was 73.1% while rate of dialysis-dependent CKD on discharge was 6.2%. Mortality rate was significantly higher in CRRT (84.6%) patients than in IHD patients (66.7%, P=0.019).
Conclusion: Our study results reveal that sepsis appears to be the most important cause of D-AKI in intensive care patients. D-AKI was observed more frequently in elderly patients and associated with an increased risk of short-term mortality.

References

  • 1. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41:1411-23.
  • 2. Wald R, Quinn RR, Luo J, Li P, Scales DC, Mamdani MM, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA. 2009;302:1179-85.
  • 3. Kılıç A, Şişik A. A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplast. J Surg Med. 2020;4(5):331-3. DOI: 10.28982/josam.737762.
  • 4. Rimes-Stigare C, Frumento P, Bottai M, Mårtensson J, Martling CR, Walther SM, et al. Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill; a Swedish multi-centre cohort study. Crit Care. 2015;19:221.
  • 5. Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007;35:1837-43.
  • 6. de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26(7):915-21.
  • 7. Kohli HS, Bhat A, Jairam A, Aravindan AN, Sud K, Jha V, et al. Predictors of mortality in acute renal failure in a developing country: a prospective study. Ren Fail. 2007;29:463-9.
  • 8. Sakhuja A, Kumar G, Gupta S, Mittal T, Taneja A, Nanchal RS. Acute kidney injury requiring dialysis in severe sepsis. Am J Respir Crit Care Med. 2015;192:951-7.
  • 9. Pickkers P, Ostermann M, Joannidis M, Zarbock A, Hoste E, Bellomo R, et al. The intensive care medicine agenda on acute kidney injury. Intensive Care Med. 2017;43:1198-209.
  • 10. Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, et al. Dialysis-requiring acute kidney injury in Denmark 2000-2012: time trends of incidence and prevalence of risk factors - a nationwide study. PLoS One. 2016;11:e0148809.
  • 11. Kidney Disease: Improving Global Outcomes (KDIGO) AKI Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;17:S1-138.
  • 12. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
  • 13. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009;113:S1-130.
  • 14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-83.
  • 15. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247-54.
  • 16. Wilson FP, Yang W, Feldman HI. Predictors of death and dialysis in severe AKI: the UPHS-AKI cohort. Clin J Am Soc Nephrol. 2013;8:527-37.
  • 17. Gallagher M, Cass A, Bellomo R, Finfer S, Gattas D, Lee J, et al. Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med. 2014;11:e1001601.
  • 18. Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, et al. Trends in one-year outcomes of dialysis-requiring acute kidney injury in Denmark 2005-2012: a population-based nationwide study. PLoS One. 2016;11:e0159944.
  • 19. Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006;17:1135-42.
  • 20. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol. 2013;24:37-42.
  • 21. Wald R, McArthur E, Adhikari NK, Bagshaw SM, Burns KE, Garg AX, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis. 2015;65:870-7.
  • 22. See EJ, Jayasinghe K, Glassford N, Bailey M, Johnson DW, Polkinghorne KR, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019;95:160-72.
  • 23. Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med. 2014;371:58-66.
  • 24. Ishani A, Xue JL, Himmelfarb J, Eggers PW, Kimmel PL, Molitoris BA, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20:223-8.
  • 25. Gammelager H, Christiansen CF, Johansen MB, Tønnesen E, Jespersen B, Sørensen HT. Five-year risk of end-stage renal disease among intensive care patients surviving dialysis-requiring acute kidney injury: a nationwide cohort study. Crit Care. 2013;17:R145.
  • 26. Harel Z, Bell CM, Dixon SN, McArthur E, James MT, Garg AX, et al. Predictors of progression to chronic dialysis in survivors of severe acute kidney injury: a competing risk study. BMC Nephrol. 2014;15:114.
  • 27. Rauf AA, Long KH, Gajic O, Anderson SS, Swaminathan L, Albright RC. Intermittent hemodialysis versus continuous renal replacement therapy for acute renal failure in the intensive care unit: an observational outcomes analysis. J Intensive Care Med. 2008;23:195-203.
  • 28. Kwizera A, Tumukunde J, Ssemogerere L, Ayebale E, Agaba P, Yakubu J, et al. Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an African intensive care unit. Biomed Res Int. 2016;2016:2015251.
  • 29. Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007;3:CD003773.
  • 30. Nash DM, Przech S, Wald R, O'Reilly D. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017;41:138-44.
  • 31. Ronco C, Ricci Z, De Backer D, Kellum JA, Taccone FS, Joannidis M, et al. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care. 2015;19:146.
  • 32. Vanholder R, Van Biesen W, Hoste E, Lameire N. Pro/con debate: continuous versus intermittent dialysis for acute kidney injury: a never-ending story yet approaching the finish? Crit Care. 2011;15:204.
  • 33. Gibney RT. Continous renal replacement therapy and intermittent hemodialysis in acute kidney injury: equivalent or complementary? J Thorac Dis. 2016;8:2397-9.
  • 34. Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, et al. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care. 2010;14:R82.
There are 34 citations in total.

Details

Primary Language English
Subjects Intensive Care
Journal Section Research article
Authors

Firdevs Tugba Bozkurt 0000-0002-1461-5933

Melek Doganci 0000-0002-3710-4570

Duygu Kayar Calili This is me 0000-0001-9251-3708

Ahmet Akdag This is me 0000-0002-7645-6640

Seval İzdes 0000-0001-9856-2391

Publication Date July 1, 2020
Published in Issue Year 2020 Volume: 4 Issue: 7

Cite

APA Bozkurt, F. T., Doganci, M., Kayar Calili, D., Akdag, A., et al. (2020). Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients. Journal of Surgery and Medicine, 4(7), 558-561. https://doi.org/10.28982/josam.749996
AMA Bozkurt FT, Doganci M, Kayar Calili D, Akdag A, İzdes S. Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients. J Surg Med. July 2020;4(7):558-561. doi:10.28982/josam.749996
Chicago Bozkurt, Firdevs Tugba, Melek Doganci, Duygu Kayar Calili, Ahmet Akdag, and Seval İzdes. “Clinical Characteristics and Short-Term Outcome of Dialysis-Requiring Acute Kidney Injury in Critically Ill Patients”. Journal of Surgery and Medicine 4, no. 7 (July 2020): 558-61. https://doi.org/10.28982/josam.749996.
EndNote Bozkurt FT, Doganci M, Kayar Calili D, Akdag A, İzdes S (July 1, 2020) Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients. Journal of Surgery and Medicine 4 7 558–561.
IEEE F. T. Bozkurt, M. Doganci, D. Kayar Calili, A. Akdag, and S. İzdes, “Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients”, J Surg Med, vol. 4, no. 7, pp. 558–561, 2020, doi: 10.28982/josam.749996.
ISNAD Bozkurt, Firdevs Tugba et al. “Clinical Characteristics and Short-Term Outcome of Dialysis-Requiring Acute Kidney Injury in Critically Ill Patients”. Journal of Surgery and Medicine 4/7 (July 2020), 558-561. https://doi.org/10.28982/josam.749996.
JAMA Bozkurt FT, Doganci M, Kayar Calili D, Akdag A, İzdes S. Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients. J Surg Med. 2020;4:558–561.
MLA Bozkurt, Firdevs Tugba et al. “Clinical Characteristics and Short-Term Outcome of Dialysis-Requiring Acute Kidney Injury in Critically Ill Patients”. Journal of Surgery and Medicine, vol. 4, no. 7, 2020, pp. 558-61, doi:10.28982/josam.749996.
Vancouver Bozkurt FT, Doganci M, Kayar Calili D, Akdag A, İzdes S. Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients. J Surg Med. 2020;4(7):558-61.