Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients
In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatini...
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| Language: | English |
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Wiley
2013-01-01
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| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2013/827459 |
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| author | Charuhas V. Thakar Annette Christianson Peter Almenoff Ron Freyberg Marta L. Render |
| author_facet | Charuhas V. Thakar Annette Christianson Peter Almenoff Ron Freyberg Marta L. Render |
| author_sort | Charuhas V. Thakar |
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| description | In a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3 mg/dl increase. Standardized mortality rates (SMR) were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI). 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29–1.42), 1.84 (1.66–2.04), and 2.25 (2.07–2.45)) and was 0.98 (0.78–1.20) in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances. |
| format | Article |
| id | doaj-art-3ddcd683fb7848cba59db5406a54126e |
| institution | Kabale University |
| issn | 2090-214X 2090-2158 |
| language | English |
| publishDate | 2013-01-01 |
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| series | International Journal of Nephrology |
| spelling | doaj-art-3ddcd683fb7848cba59db5406a54126e2025-02-03T07:25:56ZengWileyInternational Journal of Nephrology2090-214X2090-21582013-01-01201310.1155/2013/827459827459Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill PatientsCharuhas V. Thakar0Annette Christianson1Peter Almenoff2Ron Freyberg3Marta L. Render4Division of Nephrology, Cincinnati VA Medical Center, Department of Internal Medicine, University of Cincinnati, 3200 Vine Street, Cincinnati, OH 45220, USAVA Inpatient Evaluation Center, 205 West 4th Street, Cincinnati, OH 45202, USAKansas City VAMC, Department of Internal Medicine, UMKC School of Medicine, E. Linwood Boulevard, Kansas City, MO 64128, USAPulmonary and Critical Care, Cincinnati VA Medical Center, University of Cincinnati, 3200 Vine Street, Cincinnati, OH 45220, USAVA Inpatient Evaluation Center, 205 West 4th Street, Cincinnati, OH 45202, USAIn a multicenter observational cohort of patients-admitted to intensive care units (ICU), we assessed whether creatinine elevation prior to dialysis initiation in acute kidney injury (AKI-D) further discriminates risk-adjusted mortality. AKI-D was categorized into four groups (Grp) based on creatinine elevation after ICU admission but before dialysis initiation: Grp I > 0.3 mg/dL to <2-fold increase, Grp II ≥2 times but <3 times increase, Grp III ≥3-fold increase in creatinine, and Grp IV none or <0.3 mg/dl increase. Standardized mortality rates (SMR) were calculated by using a validated risk-adjusted mortality model and expressed with 95% confidence intervals (CI). 2,744 patients developed AKI-D during ICU stay; 36.7%, 20.9%, 31.2%, and 11.2% belonged to groups I, II, III, and IV, respectively. SMR showed a graded increase in Grp I, II, and III (1.40 (95% CI, 1.29–1.42), 1.84 (1.66–2.04), and 2.25 (2.07–2.45)) and was 0.98 (0.78–1.20) in Grp IV. In ICU patients with AKI-D, degree of creatinine elevation prior to dialysis initiation is independently associated with hospital mortality. It is the lowest in those experiencing minor or no elevations in creatinine and may represent reversible fluid-electrolyte disturbances.http://dx.doi.org/10.1155/2013/827459 |
| spellingShingle | Charuhas V. Thakar Annette Christianson Peter Almenoff Ron Freyberg Marta L. Render Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients International Journal of Nephrology |
| title | Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients |
| title_full | Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients |
| title_fullStr | Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients |
| title_full_unstemmed | Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients |
| title_short | Degree of Acute Kidney Injury before Dialysis Initiation and Hospital Mortality in Critically Ill Patients |
| title_sort | degree of acute kidney injury before dialysis initiation and hospital mortality in critically ill patients |
| url | http://dx.doi.org/10.1155/2013/827459 |
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