Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 16;3(4):507-514.e1.
doi: 10.1016/j.xkme.2021.02.007. eCollection 2021 Jul-Aug.

Sepsis-Associated Acute Kidney Disease and Long-term Kidney Outcomes

Alexander H Flannery  1 , Xilong Li  2 , Natalie L Delozier  1 , Robert D Toto  3 , Orson W Moe  3 , Jerry Yee  4 , Javier A Neyra  5
Affiliations

Sepsis-Associated Acute Kidney Disease and Long-term Kidney Outcomes

Alexander H Flannery et al. Kidney Med. .

Abstract

Rationale & objective: Sepsis-associated acute kidney injury often leads to acute kidney disease (AKD), predisposing patients to long-term complications such as chronic kidney disease (CKD), kidney failure with replacement therapy (KFRT), or mortality. Risk stratification of patients with AKD represents an opportunity to assist with prognostication of long-term kidney complications.

Study design: Single-center retrospective cohort.

Setting & participants: 6,290 critically ill patients admitted to the intensive care unit with severe sepsis or septic shock. Patients were separated into cohorts based on incident acute kidney injury or not, and survivors identified who were alive and free of KFRT up to 90 days.

Predictors: AKD stage (0A, 0C, or ≥1) using the last serum creatinine concentration available by discharge or up to 90 days postdischarge.

Outcome: Time to development of incident CKD, progression of CKD, KFRT, or death.

Analytical approach: Multivariable Cox proportional hazards models.

Results: Patients surviving kidney injury associated with sepsis often fail to return to baseline kidney function by discharge: 577/1,231 (46.9%) with stage 0C or 1 or greater AKD. AKD stage was significantly associated with the composite primary outcome. Stages 0C AKD and 1 or greater AKD were significantly and progressively associated with the primary outcome when compared with stage 0A AKD (adjusted HR [aHR], 1.74; 95% CI, 1.32-2.29, and aHR, 3.25; 95% CI, 2.52-4.20, respectively). Additionally, stage 1 or greater AKD conferred higher risk above stage 0C AKD (aHR, 1.87; 95% CI, 1.44-2.43). CKD incidence or progression and KFRT, more so than mortality, occurred with greater frequency in higher stages of AKD.

Limitations: Retrospective design, single center, exclusion of patients with KFRT within 90 days of discharge, potential ascertainment bias, and inability to subclassify above AKD stage 1.

Conclusions: Risk stratification using recommended AKD stages at hospital discharge or shortly thereafter associates with the development of long-term kidney outcomes following sepsis-associated acute kidney injury.

Keywords: Acute kidney disease; acute kidney injury; chronic kidney disease; end-stage renal disease; long-term outcomes; sepsis.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow diagram of patient inclusion into the cohort. Abbreviations: AKI, acute kidney injury; ICU, intensive care unit; KRT, kidney replacement therapy.
Figure 2
Figure 2
Long-term kidney outcomes based on presence of acute kidney injury (AKI) and acute kidney disease (AKD) stage. Abbreviations: CKD, chronic kidney disease; KRT, kidney replacement therapy.
Figure 3
Figure 3
Adjusted survival curve for the composite outcome of incident or progressive chronic kidney disease (CKD), kidney failure with replacement therapy (KFRT), or death. Abbreviations: AKD, acute kidney disease; AKI, acute kidney injury.
See this image and copyright information in PMC

References

    1. Bagshaw S.M., George C., Bellomo R. Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care. 2008;12(2):R47. - PMC - PubMed
    1. Bagshaw S.M., Uchino S., Bellomo R. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol. 2007;2(3):431–439. - PubMed
    1. Cruz D.N., Bolgan I., Perazella M.A. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE criteria. Clin J Am Soc Nephrol. 2007;2(3):418–425. - PubMed
    1. Uchino S., Kellum J.A., Bellomo R. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–818. - PubMed
    1. Coca S.G., Singanamala S., Parikh C.R. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442–448. - PMC - PubMed

LinkOut - more resources