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Comparative Study
. 2024 Dec;29(12):838-848.
doi: 10.1111/nep.14392. Epub 2024 Sep 18.

Sepsis-associated acute kidney injury in patients with chronic kidney disease: Patient characteristics, prevalence, timing, trajectory, treatment and associated outcomes

Kyle C White  1   2   3 , Rinaldo Bellomo  4   5   6   7 , Alexis Tabah  2   3   8 , Antony G Attokaran  2   9 , Hayden White  10   11 , James McCullough  11   12 , Kiran Shekar  2   3   13 , Mahesh Ramanan  2   14   15 , Peter Garrett  11   16 , Philippa McIlroy  17 , Siva Senthuran  18   19 , Stephen Luke  18   20 , Ary Serpa-Neto  5   21 , Tom Larsen  6   22 , Kevin B Laupland  3   23 ; Queensland Critical Care Research Network (QCCRN)
Collaborators, Affiliations
Comparative Study

Sepsis-associated acute kidney injury in patients with chronic kidney disease: Patient characteristics, prevalence, timing, trajectory, treatment and associated outcomes

Kyle C White et al. Nephrology (Carlton). 2024 Dec.

Abstract

Aim: The features and outcomes of sepsis-associated acute kidney injury (SA-AKI) may be affected by chronic kidney disease (CKD). Accordingly, we aimed to compare SA-AKI in patients with or without CKD.

Methods: Retrospective cohort study in 12 intensive care units (ICU). We studied the prevalence, patient characteristics, timing, trajectory, treatment and outcomes of SA-AKI with and without CKD.

Results: Of 84 240 admissions, 7255 (8.6%) involved patients with CKD. SA-AKI was more common in patients with CKD (21% vs 14%; p < .001). CKD patients were older (70 vs. 60 years; p < .001), had a higher median Charlson co-morbidity index (5 vs. 3; p < .001) and acute physiology and chronic health evaluation (APACHE) III score (78 vs. 60; p < .001) and were more likely to receive renal replacement therapy (RRT) (25% vs. 17%; p < .001). They had less complete return to baseline function at ICU discharge (48% vs. 60%; p < .001), higher major adverse kidney events at day 30 (MAKE-30) (38% vs. 27%; p < .001), and higher hospital and 90-day mortality (21% vs. 13%; p < .001, and 27% vs. 16%; p < .001, respectively). After adjustment for patient characteristics and severity of illness, however, CKD was not an independent risk factor for increased 90-day mortality (OR 0.88; 95% CI 0.76-1.02; p = .08) or MAKE-30 (OR 0.98; 95% CI 0.80-1.09; p = .4).

Conclusion: SA-AKI is more common in patients with CKD. Such patients are older, more co-morbid, have higher disease severity, receive different ICU therapies and have different trajectories of renal recovery and greater unadjusted mortality. However, after adjustment day-90 mortality and MAKE-30 risk were not increased by CKD.

Keywords: acute kidney injury; chronic kidney disease; critical care; sepsis; sepsis‐associated acute kidney injury.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Mean daily serum creatinine by chronic kidney disease (CKD) status. ICU, intensive care unit.
FIGURE 2
FIGURE 2
Mean hourly urine output by chronic kidney disease (CKD) status. ICU, intensive care unit; SA‐AKI, sepsis‐associated acute kidney injury.
FIGURE 3
FIGURE 3
Proportion of patients by acute kidney injury (AKI) stage according to chronic kidney disease (CKD) status. ICU, intensive care unit.
See this image and copyright information in PMC

References

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    1. White KC, Serpa‐Neto A, Hurford R, et al. Sepsis‐associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study. Intensive Care Med. 2023;49(9):1079‐1089. - PMC - PubMed
    1. White KC, Laupland KB, Tabah A, Ramanan M, Bellomo R. Details and the devil within: the case of sepsis associated AKI. Intensive Care Med. 2023;49(11):1426‐1427. - PubMed
    1. Gómez H, Zarbock A. Details and the devil within—the case of sepsis associated acute kidney injury. Intensivē Care Med. 2023;49(11):1424‐1425. - PubMed

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