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. 2016 Dec;6(1):118.
doi: 10.1186/s13613-016-0218-5. Epub 2016 Nov 29.

Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study

Henriikka Mildh  1 , Ville Pettilä  1   2 , Anna-Maija Korhonen  1 , Sari Karlsson  3 , Tero Ala-Kokko  4 , Matti Reinikainen  5 , Suvi T Vaara  6 ; FINNAKI Study Group
Collaborators, Affiliations

Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study

Henriikka Mildh et al. Ann Intensive Care. 2016 Dec.

Abstract

Background: The role of an episode of acute kidney injury (AKI) in long-term mortality among initial survivors of critical illness is controversial. We aimed to determine whether AKI is independently associated with decreased survival at 3 years among 30-day survivors of intensive care.

Results: We included 2336 30-day survivors of intensive care enrolled in the FINNAKI study conducted in seventeen medical-surgical ICUs in Finland during a 5-month period in 2011-2012. The incidence of AKI, defined by the Kidney Disease: Improving Global Outcomes criteria, was 34.6%, and 192 (8.3%) commenced RRT. The 3-year mortality among AKI patients was 23.5% (95% CI 20.6-26.4%) compared to 18.9% (17.0-20.9%) of patients without AKI, p = 0.01. However, after adjustments using Cox proportional hazards regression, AKI was not associated with decreased 3-year survival (HR 1.05; CI 95% 0.86-1.27), whereas advanced age, poor pre-morbid functional performance, and presence of several comorbidities were. Additionally, we matched AKI patients to non-AKI patients 1:1 according to age, gender, presence of severe sepsis, and a propensity score to develop AKI. In the well-balanced matched cohort, 3-year mortality among AKI patients was 136 of 662 (20.5%; 17.5-23.6%) and among matched non-AKI patients 143 of 662 (21.6%; 18.5-24.7%), p = 0.687. Neither AKI nor RRT was associated with decreased survival at 3 years in the sensitivity analyses that excluded patients (1) with chronic kidney disease, (2) with AKI not commenced renal replacement therapy (RRT), and (3) with estimated pre-admission creatinine, chronic kidney disease, or AKI stage 1.

Conclusion: AKI was not an independent risk factor for 3-year mortality among 30-day survivors. Increased 3-year mortality among patients with AKI who survive critical illness may not be related to AKI per se, but rather to advanced age and pre-existing comorbidities.

Keywords: Acute kidney injury; Intensive care; Long-term mortality; Renal replacement therapy.

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Figures

Fig. 1
Fig. 1
Study flowchart. AIDS acquired immune deficiency syndrome, AKI acute kidney injury, FINNAKI Finnish Acute Kidney Injury
Fig. 2
Fig. 2
Kaplan–Meier plot presenting the cumulative survival according to the presence of acute kidney injury. AKI acute kidney injury
Fig. 3
Fig. 3
Kaplan–Meier plot presenting the cumulative survival according to matching and acute kidney injury status. The percentage in parenthesis presents the proportion of each group of the cohort of 2336 patients. AKI acute kidney injury
See this image and copyright information in PMC

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