Background
Methods
Identification of patients
Data extraction
Definition of covariates and category
AKI group
ACKI group
Definition of renal recovery
Diuretic resistance
Statistical analysis
Results
Comparison of clinical characteristics between AKI and ACKI
Total cohort (n = 1005) | Index eGFR, ml/min/1.73 m2
| |||
---|---|---|---|---|
≥60 (n = 738) | 30 ~ 59 (n = 267) |
P
| ||
Demographics
| ||||
Age, years | 63 ± 16 | 60 ± 16 | 71 ± 12 | <0.001 |
Male, no. (%) | 625(62.2) | 461(62.5) | 164(61.4) | 0.763 |
Current smoker, no. (%) | 317(31.5) | 240(32.5) | 77(28.8) | 0.267 |
Comorbid conditions
| ||||
Diabetes, no. (%) | 368(36.6) | 243(32.9) | 125(46.8) | <0.001 |
Hypertension, no. (%) | 485(48.3) | 304(41.2) | 181(67.8) | <0.001 |
Ischemic heart disease, no. (%) | 506(50.3) | 354(48.0) | 152(56.9) | 0.012 |
Atrial fibrillation, no. (%) | 288(28.7) | 217(29.4) | 71(26.6) | 0.384 |
Cerebrovascular disease, no. (%) | 112(11.1) | 71(9.6) | 41(15.4) | 0.011 |
Comorbid sum a, no. (%) | <0.001 | |||
0 | 118(11.7) | 104(14.1) | 14(5.2) | |
1 | 305(30.3) | 250(33.9) | 55(20.6) | |
2 | 347(34.5) | 242(32.8) | 105(39.4) | |
≥3 | 235(23.4) | 142(19.2) | 93(34.9) | |
Index eGFR, ml/min/1.73 m
2
| 78 ± 25 | 89 ± 18 | 47 ± 9 | <0.001 |
Characteristics on admission
| ||||
LVEF < 45%, no. (%) | 417(41.5) | 305(41.3) | 112(41.9) | 0.860 |
NYHA class 4, no. (%)b
| 467(46.5) | 315(42.7) | 152(56.9) | <0.001 |
Systolic blood pressure, mm Hg | 130 ± 20 | 127 ± 19 | 136 ± 23 | <0.001 |
Diastolic blood pressure, mm Hg | 80 ± 22 | 79 ± 18 | 84 ± 30 | 0.002 |
Serum creatinine, μmol/L | 110 ± 64 | 90 ± 31 | 164 ± 95 | <0.001 |
Fasting plasma glucose, mmol/L | 6.5 ± 2.3 | 6.4 ± 2.3 | 6.6 ± 2.6 | 0.385 |
Serum triglyeride, mmol/L | 1.5 ± 1.4 | 1.4 ± 1.3 | 1.6 ± 1.6 | 0.353 |
Serum total cholesterol, mmol/L | 4.6 ± 1.4 | 4.6 ± 1.4 | 4.6 ± 1.3 | 0.579 |
Serum LDL-C, mmol/L | 2.3 ± 1.0 | 2.4 ± 1.0 | 2.3 ± 1.0 | 0.564 |
Serum albumin, g/L | 36.2 ± 5.6 | 36.7 ± 5.2 | 34.6 ± 6.2 | <0.001 |
Haemoglobin, g/L | 128 ± 23 | 131 ± 22 | 118 ± 24 | <0.001 |
Inotropic therapy, no. (%)
| 134(13.3) | 104(14.1) | 30(11.2) | 0.239 |
Total | Index eGFR, ml/min/1.73 m2
| |||
---|---|---|---|---|
≥60 | 30 ~ 59 |
P
| ||
AWRF incidence, n/N (%)
| 445/1005 (44.3) | 294/738 (39.8) | 151/267 (56.6) | <0.001 |
RIFLE category of AWRF, n/N (%)
| <0.001 | |||
Risk | 282/445 (63.4) | 204/294 (69.4) | 78/151 (51.7) | |
Injury | 127/445 (28.5) | 63/294 (21.4) | 64/151 (42.4) | |
Failure | 36/445(18.1) | 27/294 (9.2) | 9/151 (6.0) | |
Maximum serum creatinine during hospitalization, μmol/L
| 182 ± 118 | 145 ± 73 | 254 ± 152 | <0.001 |
Median time of maximum RIFLE class reached
a
, day
| 4 (1 ~ 8) | 4(1 ~ 8) | 4(2 ~ 8) | 0.118 |
RRT required, n/N (%)
| 25/445 (5.6) | 6/294 (2.0) | 19/151 (12.6) | <0.001 |
Diuretic resistance, n/N (%)
| 88/445(19.8) | 52/294(17.7) | 36/151(23.8) | 0.123 |
Ultrafitration for diuretic resistance, n/N (%)
| 19/445(4.3) | 6/294 (2.0) | 13/151 (8.6) | 0.002 |
Impact of AKI and ACKI on outcomes
In-hospital mortality and length of stay
Index eGFR | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
≥60 ml/min/1.73 m2
| 30 ~ 59 ml/min/1.73 m2
| |||||||||||
No AWRF (n = 444) | AKI group | No AWRF (n = 116) | ACKI group | |||||||||
All (n = 294) | Risk (n = 204) | Injury (n = 63) | Failure (n = 27) | P c
| All (n = 151) | Risk (n = 78) | Injury (n = 64) | Failure (n = 9) | P c
| |||
In-hospital mortality
| ||||||||||||
All cause mortality, no. (%) | 23(5.2) | 49(16.7) a
| 15(7.4) | 16(25.4) | 18(66.7) | <0.001 | 11(9.5) | 37(24.5) a, b
| 11(14.1) | 21(32.8) | 5(55.6) | 0.003 |
Cardiovascular mortality, no. (%) | 17(3.8) | 35(11.9) a
| 12(5.9) | 11(17.5) | 12(44.4) | <0.001 | 8(6.9) | 35(23.2) a, b
| 11(14.1) | 19 (29.7) | 5 (55.6) | 0.005 |
Outcomes of survivors
| ||||||||||||
Length of stay in CCU, days | 3(2 ~ 4) | 3(2 ~ 4) a
| 3(2 ~ 4) | 3(2 ~ 4) | 4(3 ~ 9) | 0.001 | 4(2 ~ 4) | 5(4 ~ 6) a,b
| 4(4 ~ 5) | 5(4 ~ 6) | 7(4 ~ 7) | 0.027 |
Length of stay in hospital, days | 8(6 ~ 14) | 14(9 ~ 18) a
| 12(8 ~ 17) | 17(12 ~ 27) | 20(15 ~ 33) | <0.001 | 8(6 ~ 13) | 15(11 ~ 22) a, b
| 14(8 ~ 18) | 18(14 ~ 23) | 20(9 ~ 32) | 0.001 |
Renal recovery
Re-hospitalization
Index eGFR | ||||||
---|---|---|---|---|---|---|
≥60 ml/min/1.73 m2
| 30 ~ 59 ml/min/1.73 m2
| |||||
No AWRF (n = 421) | AKI group (n = 245) |
P
| No AWRF (n = 105) | ACKI group (n = 114) |
P
| |
Total re-hospitalization, n (%)
| 80 (19.0) | 64 (26.1) | 0.031 | 19 (18.1) | 38 (33.3) | 0.010 |
For ADHF | 16 (3.8) | 22 (9.0) | 0.005 | 3 (2.9) | 16 (14.0) | 0.003 |
For other reasons | 64 (15.2) | 42 (17.1) | 0.509 | 16 (15.2) | 22 (19.3) | 0.428 |
The factors correlated with the outcomes of AKI and ACKI
Totala
| Index eGFR (ml/min/1.73 m2) | |||||
---|---|---|---|---|---|---|
≥60b
| 30 ~ 59c
| |||||
OR (95% CI) |
P
| OR (95% CI) |
P
| OR (95% CI) |
P
| |
Cerebrovascular disease (yes
vs.
no)
| 1.86 (1.05 ~ 3.29) | 0.034 | - | - | - | - |
Index eGFR < 60 ml/min/1.73 m
2
(yes
vs.
no)
| 1.66 (1.06 ~ 2.62) | 0.028 | NA | NA | NA | NA |
RIFLE category of AWRF (
vs.
no AWRF)
| 1.82 (1.14 ~ 2.90) | 0.013 | - | <0.001 | - | 0.001 |
Risk | - | - | 0.88 (0.43 ~ 1.79) | 0.715 | 0.70 (0.26 ~ 1.91) | 0.486 |
Injury | - | - | 4.20 (1.96 ~ 9.01) | <0.001 | 3.32 (1.36 ~ 8.08) | 0.008 |
Failure | - | - | 19.87 (6.35 ~ 44.79) | <0.001 | 7.38(1.50 ~ 36.37) | 0.014 |
LVEF < 45% on admission (yes
vs.
no)
| 2.16 (1.40 ~ 3.35) | 0.001 | 1.88(1.07 ~ 3.31) | 0.028 | 4.05 (1.91 ~ 8.60) | <0.001 |
NYHA class 4 on admission (yes
vs.
no)
| 2.55 (1.55 ~ 4.20) | <0.001 | 2.07(1.10 ~ 3.90) | 0.024 | 5.50 (2.07 ~ 14.62) | <0.001 |
Systolic blood pressure > 160 mmHg on admission (yes
vs.
no)
| 2.30 (1.05 ~ 5.08) | 0.039 | - | - | - | - |
Fasting plasma glucose > 7.0 mmol/L on admission (yes
vs.
no)
| 3.93 (2.54 ~ 6.07) | <0.001 | - | - | - | - |
Diuretic resistance (yes
vs.
no)
| 2.83 (1.72 ~ 4.64) | <0.001 | 3.99 (2.01 ~ 7.90) | <0.001 | 2.71 (1.17 ~ 6.28) | 0.020 |
Totala
| Index eGFR (ml/min/1.73 m2) | |||||
---|---|---|---|---|---|---|
≥60b
| 30 ~ 59c
| |||||
OR (95% CI) |
P
| OR (95% CI) |
P
| OR (95% CI) |
P
| |
Index eGFR < 60 ml/min/1.73 m
2
(yes
vs.
no)
| 2.21 (1.37 ~ 3.58) | 0.001 | NA | NA | NA | NA |
RIFLE category of AWRF (
vs.
no AWRF)
| 1.95 (1.16 ~ 3.29) | 0.012 | - | <0.001 | - | <0.001 |
Risk | - | - | 1.06 (0.48 ~ 2.33) | 0.890 | 1.07 (0.37 ~ 3.08) | 0.895 |
Injury | - | - | 3.49 (1.48 ~ 8.26) | 0.004 | 4.09 (1.56 ~ 10.70) | 0.004 |
Failure | - | - | 10.00 (3.74 ~ 26.76) | <0.001 | 10.76 (2.12 ~ 54.48) | 0.004 |
LVEF < 45% on admission (yes
vs.
no)
| 2.17 (1.35 ~ 3.51) | 0.002 | 2.02(1.08 ~ 3.77) | 0.028 | 3.37(1.55 ~ 7.30) | 0.002 |
NYHA class 4 on admission (yes
vs.
no)
| 2.58 (1.48 ~ 4.50) | 0.001 | 2.03 (1.02 ~ 4.06) | 0.045 | 5.49 (1.92 ~ 15.71) | 0.001 |
Systolic blood pressure > 160 mm Hg on admission (yes
vs.
no)
| 2.74 (1.22 ~ 6.17) | 0.015 | - | - | - | - |
Fasting plasma glucose > 7.0 mmol/L on admission (yes
vs.
no)
| 3.98 (2.46 ~ 6.43) | <0.001 | - | - | - | - |
Diuretic resistance (yes
vs.
no)
| 2.03 (1.19 ~ 3.49) | 0.010 | 2.21(1.03 ~ 4.74) | 0.042 | 2.69(1.15 ~ 6.25) | 0.022 |
Totala
| Index eGFR (ml/min/1.73 m2) | |||||
---|---|---|---|---|---|---|
≥60b
| 30 ~ 59c
| |||||
OR (95% CI) |
P
| OR (95% CI) |
P
| OR (95% CI) |
P
| |
Diabetes (yes
vs.
no)
| 2.00(1.50 ~ 2.66) | <0.001 | 1.74(1.24 ~ 2.43) | 0.001 | 2.62(1.50 ~ 4.57) | 0.001 |
Index eGFR < 60 ml/min/1.73 m
2
(yes
vs.
no)
| 1.54 (1.13 ~ 2.11) | 0.007 | NA | NA | NA | NA |
LVEF < 45% on admission (yes
vs.
no)
| 1.73 (1.31 ~ 2.29) | <0.001 | 1.59(1.15 ~ 2.20) | 0.005 | 2.39(1.36 ~ 4.20) | 0.002 |
NYHA class 4 on admission (yes
vs.
no)
| 3.10 (2.35 ~ 4.10) | <0.001 | 3.53(2.55 ~ 4.89) | <0.001 | 2.40(1.38 ~ 4.18) | 0.002 |
Systolic blood pressure > 160 mmHg on admission (yes
vs.
no)
| 3.80 (1.67 ~ 8.49) | 0.001 | 4.07(1.23 ~ 13.42) | 0.021 | 4.04(1.31 ~ 12.44) | 0.015 |
Diuretic resistance (yes
vs.
no)
| 2.09 (1.55 ~ 2.81) | <0.001 | 1.70(1.20 ~ 2.41) | 0.003 | 3.63 (1.94 ~ 6.78) | <0.001 |