Pre-existing chronic kidney disease and acute kidney injury among critically ill patients |
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| Institution: | 1. School of Nursing-the University of Jordan, Amman 11942 Jordan;2. Sheikh Khalifa Medical City, Ajman 2758 United Arab Emirates;3. Adult Health Nursing Department, Faculty of Nursing- Hashemite University, Amman 11962 Jordan;4. University of Kentucky, College of Nursing, 2201 Regency Rd, Suite 403, Lexington, KY 40503, USA;1. Gachon University, College of Nursing, Incheon, South Korea;2. Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea;3. Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, College of Medicine, Incheon, South Korea;4. Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea;5. Chonnam National University, College of Nursing, Gwangju, South Korea;6. Department of Nursing, Hanyang University Medical Center, Seoul, South Korea;7. Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea;8. Gachon University Gil Medical Center, Incheon, South Korea;9. Mercer University, Georgia Baptist College of Nursing, Atlanta, USA;1. Department of Critical Care Medicine, The First Affiliated Hospital, China Medical University, North Nanjing Street 155, Shenyang 110001, Liaoning Province, China;2. Department of Critical Care Medicine, The Sixth People’ s Hospital of Shenyang, South Heping Street 85,Shenyang, Liaoning Province, China;3. Department of infection, The Sixth People’ s Hospital of Shenyang, South Heping Street 85,Shenyang, Liaoning Province, China;1. Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States;2. Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States;3. University College Cork School of Medicine, College Road, Cork T12 K8AF, Ireland;1. Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts United States, 01608;2. Division of Pulmonary and Critical care, Mayo Clinic, Rochester, Minnesota, Massachusetts United States, 55902;3. Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 492099, India;1. Faculty of Medicine, Minia University, Minia, Egypt;2. Sulaiman Al Rajhi University, College of Medicine, Qassim, Saudi Arabia;3. Faculty of Medicine, Mansoura University, Mansoura, Egypt;4. Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt;1. Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States;2. Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States |
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| Abstract: | BackgroundThe impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common.Objectives: To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI.MethodsA multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m2 on admission.ResultsPre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02–1.05;(P<0.001) and AKI (1.68; 95% CI 1.12–2.5;P<0.01) in patients with pre-existing CKD. Only APACHI-II (1.03; 95% CI 1.0–1.1; p < 0.001) was predictive of death in patients without pre-existing CKD.Conclusion: Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality. |
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