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Clinical trajectories and impact of acute kidney disease after acute kidney injury in the intensive care unit: a 5-year single-center cohort study.

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Orieux, Arthur | Prezelin-Reydit, Mathilde | Prevel, Renaud | Combe, Christian | Gruson, Didier | Boyer, Alexandre | Rubin, Sébastien

Edité par CCSD ; Oxford University Press -

Patients suffering from acute kidney injury (AKI) in intensive care unit (ICU) could have various renal trajectories and outcomes. Aims were to assess the various clinical trajectories after AKI in ICU and to determine risk factors for developing chronic kidney disease (CKD). We conducted a prospective five-year follow-up study in a medical ICU in Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion or both and developed an AKI from September 2013 to May 2015 were included. In the Cox analysis, the violation of the proportional hazard assumption for AKD was handled using appropriate interaction terms with time, resulting in time-dependent HR. 232 patients were enrolled. Age was 62 ± 16 years and median follow-up was 52 [6-1553] days. At day 7, 109/232 (47%) patients progressed to Acute Kidney Disease (AKD) and 66/232 (28%) recovered. A linear trajectory (AKI, AKD then CKD) was followed by 44/63 (70%) of CKD patients. The cumulative incidence of CKD was 30 [24-36] % at 5-year follow-up. In a multivariable Cox model, in the six months following AKI, the HR for CKD was higher in AKD patients (HR 29.2 [8.5-100.7]; p<0.0001). After six months, HR for CKD was 2.2 [0.6-7.9]; p = 0.21 (n = 172 patients). There were several clinical trajectories of kidney disease after ICU acquired AKI. CKD risk was higher in AKD patients only in the first six months. Lack of renal recovery, rather than AKD per se, was associated with the risk of CKD.

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