RESUMO
Abstract Objective: to establish the renal outcomes of patients needing dialysis due to acute kidney injury who were admitted to the intensive care unit at Hospital Departamental Universitario Santa Sofía de Caldas from 2006 to 2018, and determine the factors associated with these outcomes. Methods: a retrospective cohort study carried out at Hospital Departamental Universitario Santa Sofía de Caldas on 122 patients over the age of 18 who required dialysis in the intensive care unit due to acute kidney injury, from 2006 to 2018. The major adverse kidney events (MAKE) composite outcome was evaluated, composed of partial recovery of kidney function, dialysis dependence and death, with 90-day and one-year follow up. Results: there is a relationship between diabetes, the APACHE II score, metabolic acidosis, anuria and the dialysis start time and MAKE at 90 days and one year. In the logistic regression, patients who developed MAKE at 90 days had a greater probability of having had anuria (OR=6.71; 95%CI: 1,497-30,076), acidosis (OR=4,349; 95%CI: 1,616-11.7) and a late treatment start (OR=3,013; 95%CI: 1,241-7,316). The one-year MAKE showed similar results, with the addition of the continu ous therapy modality (OR=2,841; 95%CI: 1,193-6,763). Conclusions: diabetes, a high APACHE II, anuria, metabolic acidosis and late dialysis treat ment are more frequent in patients who develop MAKE. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2229).
Resumen Objetivo: determinar los desenlaces renales de los pacientes con requerimiento de diálisis por lesión renal aguda, que ingresaron a la unidad de cuidado intensivo del Hospital Departamental Universitario Santa Sofía de Caldas desde el año 2006 a 2018 y determinar los factores asociados a estos desenlaces. Métodos: estudio retrospectivo de cohortes llevado a cabo en el Hospital Departamental Universitario Santa Sofía de Caldas en 122 pacientes mayores de 18 años, que requirieron diálisis por lesión renal aguda en la unidad de cuidado intensivo entre los años 2006 y 2018. Se evaluó el desenlace compuesto del MAKE (Major Adverse Kidney Events) conformado por recuperación parcial de la función renal, dependencia de la diálisis y muerte con seguimiento a los 90 días y un año. Resultados: existe asociación entre diabetes, puntaje APACHE II, acidosis metabólica, anuria y tiempo de inicio de la diálisis con el MAKE a 90 días y al año. En la regresión logística aquellos pacientes que desarrollaron MAKE a los 90 días tenían mayor probabilidad de haber presentado anuria (OR=6.71; IC95%: 1497-30 076), acidosis (OR=4349; IC95%: 1616-11.7) e inicio tardío de la terapia (OR=3013; IC95%: 1241-7316). En el MAKE a un año hubo resultados similares, adicionando modalidad de terapia continua (OR=2841; IC95%: 1193-6763). Conclusiones: diabetes, APACHE II alto, anuria, acidosis metabólica y terapia dialítica tardía son más frecuentes en pacientes que desarrollan MAKE. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2229).
RESUMO
BACKGROUND/AIMS: Little is known regarding the incidence rate of and factors associated with developing chronic kidney disease after continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) patients. We investigated renal outcomes and the factors associated with incomplete renal recovery in AKI patients who received CRRT. METHODS: Between January 2011 and November 2013, 408 patients received CRRT in our intensive care unit. Of them, patients who had normal renal function before AKI and were discharged without maintenance renal replacement therapy (RRT) were included in this study. We examined the incidence of incomplete renal recovery with an estimated glomerular filtration rate < 60 mL/min/1.73 m² and factors that increased the risk of incomplete renal recovery after AKI. RESULTS: In total, 56 AKI patients were discharged without further RRT and were followed for a mean of 8 months. Incomplete recovery of renal function was observed in 20 of the patients (35.7%). Multivariate analysis revealed old age and long duration of anuria as independent risk factors for incomplete renal recovery (odds ratio [OR], 1.231; 95% confidence interval [CI], 1.041 to 1.457; p = 0.015 and OR, 1.064; 95% CI, 1.001 to 1.131; p = 0.047, respectively). In a receiver operating characteristic curve analysis, a cut-off anuria duration of 24 hours could predict incomplete renal recovery after AKI with a sensitivity of 85.0% and a specificity of 66.7%. CONCLUSIONS: The renal outcome of severe AKI requiring CRRT was poor even in patients without further RRT. Long-term monitoring of renal function is needed, especially in severe AKI patients who are old and have a long duration of anuria.