Acute Kidney Injury Recovery Patterns in Critically Ill Patients: Results of a Retrospective Cohort Study.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
8
4
2021
medline:
14
9
2021
entrez:
7
4
2021
Statut:
ppublish
Résumé
Acute kidney injury, acute kidney injury severity, and acute kidney injury duration are associated with both short- and long-term outcomes. Despite recent definitions, only few studies assessed pattern of renal recovery and time-dependent competing risks are usually disregarded. Our objective was to describe pattern of acute kidney injury recovery, change of transition probability over time and their risk factors. Monocenter retrospective cohort study. Acute kidney injury was defined according to Kidney Disease Improving Global Outcomes definition. Renal recovery was defined as normalization of both serum creatinine and urine output criteria. Competing risk analysis, time-inhomogeneous Markov model, and group-based trajectory modeling were performed. Monocenter study. Consecutive patients admitted in ICU from July 2018 to December 2018 were included. None. Three-hundred fifty patients were included. Acute kidney injury occurred in 166 patients at ICU admission, including 64 patients (38.6%) classified as acute kidney disease according to Acute Disease Quality Initiative definition and 44 patients (26.5%) who could not be classified. Cumulative incidence of recovery was 25 % at day 2 (95% CI, 18-32%) and 35% at day 7 (95% CI, 28-42%). After adjustment, need for mechanical ventilation (subdistribution hazard ratio, 0.42; 95% CI, 0.23-0.74) and severity of the acute kidney injury (stage 3 vs stage 1 subdistribution hazard ratio, 0.11; 95% CI, 0.03-0.35) were associated with lack of recovery. Group-based trajectory modeling identified three clusters of temporal changes in this setting, associated with both acute kidney injury recovery and patients' outcomes. In this study, we demonstrate Acute Disease Quality Initiative to allow recovery pattern classification in 75% of critically ill patients. Our study underlines the need to take into account competing risk factors when assessing recovery pattern in critically ill patients.
Identifiants
pubmed: 33826581
doi: 10.1097/CCM.0000000000005008
pii: 00003246-202107000-00033
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e683-e692Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Mariotte reports personal fees from Sanofi outside the submitted work. Dr. Valade reports personal fees for teaching from Sanofi and Gilead, “invitation to congress” from Pfizer, and personal fees from PR editions for expert opinion outside the submitted work. Dr. Zafrani’s institution received funding from Jazz Pharmaceuticals outside the submitted work. Dr. Azoulay has received fees for lectures from Gilead, Pfizer, Baxter, and Alexion, and his research group has been supported by Ablynx, Fisher & Paykel, Jazz Pharma, and MSD. Dr. Darmon declares having received a grant from MSD, speaker fees from MSD, Astellas, and Gilead-Kite and having attended an advisory board for Gilead-Kite. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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