학술논문
Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study
Document Type
Original Paper
Author
Mildh, Henriikka; Pettilä, Ville; Korhonen, Anna-Maija; Karlsson, Sari; Ala-Kokko, Tero; Reinikainen, Matti; Vaara, Suvi T.; Laru-Sompa, Raili; Pulkkinen, Anni; Saarelainen, Minna; Reilama, Mikko; Tolmunen, Sinikka; Rantalainen, Ulla; Miettinen, Marja; Suvela, Markku; Pesola, Katrine; Saastamoinen, Pekka; Kauppinen, Sirpa; Pettilä, Ville; Kaukonen, Kirsi-Maija; Nisula, Sara; Vaara, Suvi; Suojaranta-Ylinen, Raili; Mildh, Leena; Haapio, Mikko; Nurminen, Laura; Sutinen, Sari; Pettilä, Leena; Laitinen, Helinä; Syrjä, Heidi; Henttonen, Kirsi; Lappi, Elina; Boman, Hillevi; Varpula, Tero; Porkka, Päivi; Sivula, Mirka; Rahkonen, Mira; Tsurkka, Anne; Nieminen, Taina; Pirttinen, Niina; Alaspää, Ari; Salanto, Ville; Juntunen, Hanna; Sanisalo, Teija; Parviainen, Ilkka; Uusaro, Ari; Ruokonen, Esko; Bendel, Stepani; Rissanen, Niina; Lång, Maarit; Rahikainen, Sari; Rissanen, Saija; Ahonen, Merja; Halonen, Elina; Vaskelainen, Eija; Poukkanen, Meri; Lintula, Esa; Suominen, Sirpa; Heikkinen, Jorma; Lavander, Timo; Heinonen, Kirsi; Juopperi, Anne-Mari; Kaminski, Tadeusz; Gäddnäs, Fiia; Kuusela, Tuija; Roiko, Jane; Karlsson, Sari; Reinikainen, Matti; Surakka, Tero; Jyrkönen, Helena; Eiserbeck, Tanja; Kallinen, Jaana; Ala-Kokko, Tero; Laurila, Jouko; Sälkiö, Sinikka; Lund, Vesa; Tuominen, Päivi; Perkola, Pauliina; Tuominen, Riikka; Hietaranta, Marika; Johansson, Satu; Hovilehto, Seppo; Kirsi, Anne; Tiainen, Pekka; Myllärinen, Tuija; Leino, Pirjo; Toropainen, Anne; Kuitunen, Anne; Tenhunen, Jyrki; Leppänen, Ilona; Levoranta, Markus; Hoppu, Sanna; Sauranen, Jukka; Kukkurainen, Atte; Kortelainen, Samuli; Varila, Simo; Inkinen, Outi; Koivuviita, Niina; Kotamäki, Jutta; Laine, Anu; Koivisto, Simo-Pekka; Hautamäki, Raku; Skinnar, Maria; the FINNAKI Study Group
Source
Annals of Intensive Care. December 2016 6(1):1-9
Subject
Language
English
ISSN
2110-5820
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.