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Observational Study
. 2014 Aug 7;9(8):1347-53.
doi: 10.2215/CJN.08300813. Epub 2014 May 29.

Acute respiratory distress syndrome and risk of AKI among critically ill patients

Michael Darmon  1 , Christophe Clec'h  2 , Christophe Adrie  2 , Laurent Argaud  2 , Bernard Allaouchiche  2 , Elie Azoulay  2 , Lila Bouadma  2 , Maïté Garrouste-Orgeas  2 , Hakim Haouache  2 , Carole Schwebel  2 , Dany Goldgran-Toledano  2 , Hatem Khallel  2 , Anne-Sylvie Dumenil  2 , Samir Jamali  2 , Bertrand Souweine  2 , Fabrice Zeni  2 , Yves Cohen  2 , Jean-François Timsit  2
Affiliations
Observational Study

Acute respiratory distress syndrome and risk of AKI among critically ill patients

Michael Darmon et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Increasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.

Design, setting, participants, & measurements: This was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays >24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.

Results: This study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P<0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P<0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P<0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P<0.001).

Conclusions: ARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.

Keywords: ARF; clinical nephrology; hypoxia.

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Figures

Figure 1.
Figure 1.
Flow chart of patients admitted during the study period. ARDS, acute respiratory distress syndrome; FLST, decision to forgo life-sustaining therapies.
Figure 2.
Figure 2.
Cumulative risk of AKI in patients with and without ARDS.
See this image and copyright information in PMC

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