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. 2013:2013:827459.
doi: 10.1155/2013/827459. Epub 2013 Jan 8.

Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients

Charuhas V Thakar  1 , Annette Christianson, Peter Almenoff, Ron Freyberg, Marta L Render
Affiliations

Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients

Charuhas V Thakar et al. Int J Nephrol. 2013.

Abstract

In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3 mg/dl increase. Standardized mortality rates (SMR) were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI). 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29-1.42), 1.84 (1.66-2.04), and 2.25 (2.07-2.45)) and was 0.98 (0.78-1.20) in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances.

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Figures

Figure 1
Figure 1
Percent of dialysis patients initiating dialysis after ICU admission.
Figure 2
Figure 2
Frequency of AKI patients by degree of creatinine elevation prior to dialysis initiation. (group (Grp) I: 0.3 mg/dl to <2 times increase; II: ≥2 to <3 times increase; III: >3 times increase; IV: <0.3 mg/dl increase in creatinine before dialysis initiation).
Figure 3
Figure 3
Standardized mortality rate (SMR) in AKI requiring dialysis by degree of creatinine elevation, stratified by severity of illness on ICU admission. (group (Grp) I: 0.3 mg/dL to <2 time increase; II: ≥2 to <3 times increase; III: >3 times increase; IV: <0.3 mg/dL increase in creatinine before dialysis initiation; predicted mortality on ICU admission: <10%—n, 728; 10–30%—n, 765; > 30%, n, 1,251).
See this image and copyright information in PMC

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