Background
Methods
Study cohort
Definitions
Study outcomes
Data collection
Statistical analysis
Results
Total cohort | 1-year survivors | 1-year nonsurvivors |
P value | MAKE |
P value | ||
---|---|---|---|---|---|---|---|
1-year absent | 1-year present | ||||||
Number of patients | 959 | 340 | 619 | 102 | 752 | ||
Demographics | |||||||
Age, years | 65 (55–75) | 64 (52–74) | 65 (55–75) |
0.030
| 66 (57–74) | 65 (55–75) |
0.802
|
Male sex, % | 65.4 | 70.0 | 62.8 |
0.026
| 64.6 | 64.0 |
0.892
|
Black race, % | 0.2 | 0 | 0.3 |
0.294
| 0 | 0.3 |
0.593
|
Comorbid conditions | |||||||
Diabetes mellitus, % | 27.5 | 27.4 | 27.6 |
0.928
| 29.4 | 28.6 |
0.864
|
Baseline CKD KDIGO stage ≥3, % | 39.6 | 44.2 | 37.0 |
0.084
| 51.6 | 37.3 |
0.010
|
Baseline eGFR, ml/minute/1.73 m2
| 69.0 (47.0–91.1) | 63.4 (44.4–82.9) | 74.1 (49.2–93.8) |
0.004
| 57.3 (42.8–76.5) | 72.9 (49.2–93.4) |
0.001
|
Baseline serum creatinine, mg/dl | 1.07 (0.82–1.41) | 1.15 (0.92–1.48) | 1.00 (0.79–1.31) |
<0.001
| 1.21 (0.96–1.58) | 1.03 (0.80–1.34) |
<0.001
|
Characteristics at ICU admission | |||||||
Type of ICU | |||||||
Medical, % | 45.8 | 36.4 | 51.1 |
<0.001
| 32.0 | 49.6 |
0.001
|
Surgical, % | 54.2 | 63.6 | 48.9 | 68.0 | 50.4 | ||
Timing of surgery | |||||||
Urgent, % | 61.0 | 60.2 | 61.8 |
0.729
| 60.2 | 61.8 |
0.729
|
Elective, % | 39.0 | 39.8 | 38.2 | 39.8 | 38.2 | ||
Severity of illness | |||||||
SAPS II | 63 (45–78) | 52 (39–69) | 70 (54–83) |
<0.001
| 49 (34–69) | 68 (49–82) |
<0.001
|
Characteristics at initiation of RRT | |||||||
Severity of illness | |||||||
SOFA score, total | 10 (6–14) | 9 (5–12) | 12 (8–15) |
<0.001
| 5 (1–9) | 11 (7–14) |
<0.001
|
SOFA score, nonrenal | 7 (3–11) | 6 (2–9) | 8 (5–12) |
<0.001
| 8 (5–12) | 8 (4–11) |
<0.001
|
Mechanical ventilation, % | 88.6 | 82.4 | 92.0 |
<0.001
| 80.8 | 90.1 |
0.006
|
Vasoactive medication, % | 66.2 | 52.0 | 74.0 |
<0.001
| 48.0 | 70.4 |
<0.001
|
Renal characteristics | |||||||
Oliguria, % | 48.9 | 45.8 | 50.8 | 0.171 | 36.6 | 50.9 |
0.010
|
Fluid balance, ml | 2163 (1180–3578) | 2021 (1019–3220) | 2200 (1268–4000) |
0.049
| 1919 (1003–2996) | 2229 (1311–4000) |
0.054
|
Urine output, ml | 561 (178–1080) | 621 (246–1230) | 529 (157–1020) |
0.055
| 792 (297–1483) | 529 (152–1055) |
0.007
|
Diuretics, % | 49.3 | 56.7 | 45.2 |
0.001
| 61.3 | 45.9 |
<0.001
|
ICU to RRT length of stay, days | 2 (1–7) | 2 (1–5) | 2 (1–8) |
0.050
| 2 (1–6) | 3 (1–8) |
0.144
|
Serum creatinine, mg/dl | 3.57 (2.62–4.69) | 4.23 (3.26–5.58) | 3.26 (2.38–4.25) |
<0.001
| 4.18 (3.11–5.14) | 3.38 (2.47–4.44) |
<0.001
|
Laboratory parameters | |||||||
Serum hemoglobin, g/dl | 9.3 (8.3–10.3) | 9.5 (8.6–10.5) | 9.2 (8.2–10.2) |
0.001
| 9.4 (8.6–10.4) | 9.2 (8.2–10.2) |
0.001
|
Platelets, ×103/mm3
| 115 (67–184) | 146 (89–219) | 100 (55–158) |
<0.001
| 144 (89–202) | 104 (60–177) |
<0.001
|
Serum sodium, mmol/L | 139 (135–144) | 138 (134–142) | 140 (136–145) |
<0.001
| 137 (133–142) | 140 (136–144) |
<0.001
|
Serum potassium, mmol/L | 4.6 (4.1–5.3) | 4.8 (4.2–5.4) | 4.6 (4.1–5.2) |
0.012
| 4.9 (4.2–5.4) | 4.6 (4.1–5.2) |
0.007
|
Serum chloride, mmol/L | 102 (98–107) | 101 (97–106) | 103 (98–108) |
0.051
| 101 (97–106) | 103 (98–108) |
0.005
|
Serum bilirubin, mg/dl | 1.6 (0.7–4.2) | 1.3 (0.6–3.3) | 1.7 (0.7–4.8) |
0.004
| 1.35 (0.60–2.90) | 1.27 (0.86–1.82) |
0.001
|
Serum urea, g/dl | 1.28 (0.90–1.83) | 1.33 (0.99–1.83) | 1.26 (0.85–1.87) |
0.062
| 1.36 (1.00–1.85) | 1.27 (0.86–1.82) |
0.173
|
Serum albumin, g/dl | 2.2 (1.8–2.6) | 2.3 (2.0–2.8) | 2.1 (1.8–2.5) |
<0.001
| 2.3 (2.0–2.6) | 2.2 (1.8–2.6) |
0.003
|
Lactate, mg/dl | 24 (12–82) | 15 (10–36) | 34 (15–100) |
<0.001
| 14 (9–29) | 29 (14–94) |
<0.001
|
pH | 7.30 (7.24–7.37) | 7.34 (7.27–7.39) | 7.29 (7.21–7.36) |
<0.001
| 7.33 (7.27–7.38) | 7.29 (7.22–7.36) |
<0.001
|
Base excess | −5.2 (−8.3, −2.2) | −4.2 (−6.4, −1.6) | −6.0 (−9.4, −2.5) |
<0.001
| −4.5 (−7.1, −1.8) | −5.5 (−9.1, −2.5) |
0.001
|
RRT modality | |||||||
IHD, % | 54.0 | 67.6 | 46.4 |
<0.001
| 72.5 | 49.5 |
<0.001
|
SLEDD, % | 15.8 | 16.2 | 15.6 | 14.7 | 15.5 | ||
CRRT, % | 30.2 | 16.2 | 38.0 | 12.7 | 35.0 | ||
Timing of initiation of RRT | |||||||
Late (KDIGO stage ≥3), % | 54.1 | 58.9 | 51.6 |
0.087
| 61.1 | 58.8 |
0.735
|
Patient outcome and long-term survival
Kidney outcomes
Complete renal recovery | Incomplete renal recovery | Dialysis dependence |
P value | |
---|---|---|---|---|
Number of patients (%) | 89 (48.4) | 60 (32.6) | 35 (19.0) | |
Demographics | ||||
Age, years (IQR) | 67 (57–75) | 64 (53–75) | 66 (55.75) |
0.682
|
Male sex, % | 64.0 | 80.0 | 57.1 |
0.039
|
Black race, % | 0 | 0 | 0 |
NA
|
Comorbidities | ||||
Diabetes mellitus, % | 32.6 | 21.7 | 57.1 |
0.002
|
eGFR, ml/minute/1.73 m2
| 60.6 (43.0–77.2) | 73.6 (56.0–95.4) | 44.6 (27.1–67.4) |
<0.001
|
Baseline CKD stage ≥3, % | 49.4 | 28.3 | 69.6 |
0.013
|
Baseline serum creatinine, mg/dl | 1.17 (0.94–1.56) | 1.05 (0.83–1.29) | 1.41 (1.11–2.42) |
0.001
|
Characteristics at ICU admission | ||||
Type of ICU | ||||
Medical, % | 32.2 | 35.0 | 48.5 |
0.246
|
Surgical, % | 67.8 | 65.0 | 51.5 | |
Timing of surgery | ||||
Urgent, % | 55.4 | 64.1 | 70.6 |
0.459
|
Elective, % | 44.6 | 35.9 | 29.4 | |
Severity of illness | ||||
APACHE II score | 25 (19–35) | 24 (21–27) | 27 (19.31) |
0.948
|
SAPS II | 50 (35–69) | 55 (43–69) | 53 (44–71) |
0.871
|
Characteristics at initiation of RRT | ||||
Severity of illness | ||||
SOFA score | 8 (5–12) | 9 (5–12) | 5 (5–11) |
0.736
|
SOFA score, nonrenal | 5 (2–9) | 7 (2–9) | 2 (1–7) |
0.727
|
Mechanical ventilation, % | 78.2 | 85.0 | 64.5 |
0.082
|
Vasoactive medication, % | 43.7 | 55.0 | 35.5 |
0.172
|
Renal characteristics | ||||
Oliguria, % | 39.5 | 41.5 | 69.0 |
0.019
|
Fluid balance, ml | 1774 (997–3016) | 2546 (1364–3551) | 2713 (2103–4534) |
0.059
|
Urine output, ml | 768 (253–1496) | 665 (351–1225) | 219 (98–1080) |
0.052
|
Diuretics, % | 63.2 | 58.6 | 40.0 |
0.084
|
ICU length of stay to initiation of RRT, days | 3 (1–4) | 3 (2–9) | 2 (0–4) |
0.606
|
Laboratory parameters | ||||
Serum hemoglobin, g/dl | 9.8 (8.9–10.8) | 9.3 (8.3–10.5) | 9.6 (8.3–10.6) |
0.241
|
Serum platelets, ×103/mm3
| 143 (80–195) | 164 (87–272) | 198 (90–265) |
0.214
|
Serum sodium, mmol/L | 136 (132–140) | 140 (136–142) | 139 (133–142) |
0.011
|
Serum potassium, mmol/L | 5.0 (4.4–5.5) | 4.9 (4.2–5.3) | 4.7 (4.2–5.1) |
0.264
|
Serum chloride, mmol/L | 100 (96–105) | 102 (97–108) | 101 (97–108) |
0.081
|
Serum urea, g/dl | 1.32 (1.09–1.715) | 1.27 (0.92–1.78) | 1.34 (1.03–1.97) |
0.664
|
Serum creatinine, mg/dl | 4.23 (3.27–5.05) | 3.95 (3.07–5.08) | 4.73 (3.37–6.54) |
0.194
|
Serum albumin, g/dl | 2.3 (2.0–2.8) | 2.3 (1.9–2.6) | 2.8 (2.2–3.3) |
0.074
|
Lactate, mg/dl | 17 (11–33) | 16 (11–83) | 11 (7–94) |
0.259
|
pH | 7.34 (7.29–7.39) | 7.33 (7.25–7.39) | 7.33 (7.24–7.38) |
0.481
|
Base excess | −4.0 (−6.6, −1.6) | −4.6 (−6.5, −2.9) | −4.5 (−7.3, −3.3) |
0.628
|
RRT modality | ||||
IHD, % | 73.0 | 68.3 |
74.3
|
0.799
|
SLEDD, % | 14.6 | 16.7 | 8.6 | |
CRRT, % | 12.4 | 15.0 | 17.1 | |
Timing of initiation of RRTa
| ||||
Early, % | 46.1 | 35.0 | 50.0 |
0.309
|
Late, % | 53.9 | 65.0 | 50.0 |
Kidney outcome | Total | Preexisting CKD KDIGO stage <3 | Preexisting CKD KDIGO stage ≥3 |
P value |
---|---|---|---|---|
Hospital discharge | ||||
Complete renal recovery, % | 47.8 | 47.2 | 51.3 |
0.055
|
Incomplete renal recovery, % | 38.4 | 45.7 | 32.3 | |
Dialysis dependence, % | 13.8 | 7.1 | 14.6 | |
90 days | ||||
Complete renal recovery, % | 56.7 | 55.8 | 65.2 |
0.010
|
Incomplete renal recovery, % | 28.1 | 34.6 | 15.2 | |
Dialysis dependence, % | 15.2 | 9.6 | 19.7 | |
1 year | ||||
Complete renal recovery, % | 48.4 | 47.4 | 57.1 |
0.001
|
Incomplete renal recovery, % | 32.6 | 45.3 | 22.1 | |
Dialysis dependence, % | 19.0 | 7.4 | 20.8 | |
2 years | ||||
Complete renal recovery, % | 41.5 | 34.7 | 57.1 |
<0.001
|
Incomplete renal recovery, % | 39.5 | 61.1 | 22.2 | |
Dialysis dependence, % | 19.0 | 4.2 | 20.6 | |
3 years | ||||
Complete renal recovery, % | 39.8 | 39.1 | 51.0 |
<0.001
|
Incomplete renal recovery, % | 32.0 | 51.6 | 15.7 | |
Dialysis dependence, % | 28.1 | 9.4 | 33.3 | |
MAKE | ||||
Hospital discharge, % | 83.1 | 87.3 | 51.0 |
<0.001
|
90 days, % | 86.0 | 81.9 | 78.2 |
0.280
|
1 year, % | 87.5 | 87.4 | 79.4 |
0.010
|
2 years, % | 92.4 | 92.4 | 84.2 |
0.002
|
3 years, % | 93.7 | 92.4 | 88.5 |
0.124
|