Introduction
Methods
Setting
Intensive care patients
Acute kidney injury
Stage | Serum creatinine criteria |
---|---|
1 | 1.5-1.9 times baseline |
OR | |
≥ 26.5 5 μmol/l (0.3 mg/dl) increase within 48 hoursa | |
2 | 2.0-2.9 times baseline |
3 | ≥ 3.0 times baseline |
OR | |
Increase in serum creatinine to ≥ 354 μmol/l (4.0 mg/dl)b | |
OR | |
Initiation of renal replacement therapy |
Heart failure, myocardial infarction, and stroke
Renal recovery at hospital discharge
Covariates
Statistical analyses
Without AKI | AKI stage 1 | AKI stages 2-3 | |
---|---|---|---|
n = 16,764 | n = 2,666 | n = 2,126 | |
Age
| |||
Age, median (IQR) | 57 (39-69) | 68 (58-77) | 67 (56-75) |
Gender
| |||
Female | 7,788 (46.5) | 1,031 (38.7) | 944 (44.4) |
Male | 8,976 (53.5) | 1,635 (61.3) | 1,182 (55.6) |
Comorbidity
| |||
Ischemic heart disease except MIa | 1,863 (11.1) | 513 (19.2) | 244 (11.5) |
Cerebrovascular disease except strokeb | 537 (3.2) | 124 (4.7) | 86 (4.0) |
Diabetes | 1,490 (8.9) | 460 (17.3) | 433 (20.4) |
Chronic kidney disease | 1,063 (6.3) | 502 (18.8) | 338 (15.9) |
Hypertension | 2,216 (13.2) | 664 (24.9) | 511 (24.0) |
Peripheral vascular disease | 721 (4.3) | 266 (10.0) | 202 (9.5) |
Cancer | 2,282 (13.6) | 522 (19.6) | 375 (17.6) |
No surgery | 6,455 (38.5) | 662 (24.8) | 793 (37.3) |
Surgery | |||
Acute cardiac surgery | 195 (1.2) | 88 (3.3) | 59 (2.8) |
Acute noncardiac surgery | 5,558 (33.2) | 834 (31.3) | 764 (35.9) |
Elective cardiac surgery | 1,701 (10.1) | 528 (19.8) | 169 (7.9) |
Elective noncardiac surgery | 2,855 (17.0) | 554 (20.8) | 341 (16.0) |
Preadmission drug use
| |||
ACE inhibitors/AT2 antagonists | 2,677 (16.0) | 763 (28.6) | 698 (32.8) |
Beta blockers | 2,318 (13.8) | 667 (25.0) | 487 (22.9) |
Calcium channel antagonists | 1,587 (9.5) | 483 (18.1) | 401 (18.9) |
Acetylsalicylic acid | 5,286 (31.5) | 1,362 (51.1) | 1,005 (47.3) |
Diuretics | 1,348 (8.0) | 357 (13.4) | 272 (12.8) |
Nitrates | 756 (4.5) | 236 (8.9) | 83 (3.9) |
Statins | 2,533 (15.1) | 671 (25.2) | 441 (20.7) |
NSAIDs | 2,486 (14.8) | 430 (16.1) | 436 (20.5) |
Primary diagnosis during current hospitalization
| |||
Infectious diseases | 1,673 (10.0) | 276 (10.4) | 434 (20.4) |
Endocrine diseases | 302 (1.8) | 69 (2.6) | 99 (4.7) |
Cardiovascular diseases | 2,910 (17.4) | 873 (32.7) | 390 (18.3) |
Respiratory diseases | 741 (4.4) | 118 (4.4) | 108 (5.1) |
Gastrointestinal or liver diseases | 1,564 (9.3) | 287 (10.8) | 303 (14.3) |
Cancer or other neoplasm | 2,463 (14.7) | 471 (17.7) | 304 (14.3) |
Trauma or poisoning | 4,198 (25.0) | 282 (10.6) | 190 (8.9) |
Other | 2,913 (17.4) | 290 (10.9) | 298 (14.0) |
Laboratory information
| |||
Measured baseline creatinine | 10,213 (60.9) | 2,143 (80.4) | 1,610 (75.7) |
Maximum creatinine during admission,c μmol/l, mean (IQR) | 74 (62-88) | 123 (101-149) | 254 (180-397) |
ICU treatments
| |||
Mechanical ventilation | 4,362 (26.0) | 1,297 (48.6) | 1,126 (53.0) |
Inotropes/vasopressors | 3,083 (18.4) | 1,158 (43.4) | 1,155 (52.9) |
Length of admission
| |||
In-hospital daysd, median (IQR) | 8 (3-15) | 15 (10-28) | 23 (12-45) |
Results
Characteristics of the study population
Risk of heart failure
Without AKI | AKI stage 1 | AKI stages 2-3 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Events, n | Cumulative risk % (95% CI) | Events, n | Cumulative risk % (95% CI) | Unadjusted HR (95% CI) | Adjusted HRa(95% CI) | Events, n | Cumulative risk % (95% CI) | Unadjusted HR (95% CI) | Adjusted HRa(95% CI) | |
HF | 320 | 2.2 (2.0-2.5) | 114 | 5.0 (4.2-6.0) | 2.43 (1.96-3.01) | 1.33 (1.06-1.66) | 91 | 5.0 (4.0-6.1 | 2.53 (2.01-3.01) | 1.45 (1.14-1.84) |
MI | 135 | 1.0 (0.8-1.2) | 38 | 1.8 (1.3-2.4) | 1.93 (1.35-2.76) | 1.04 (0.71-1.51) | 40 | 2.3 (1.7-3.1) | 2.68 (1.88-3.82) | 1.51 (1.05-2.18) |
Stroke | 131 | 0.9 (0.8-1.1) | 35 | 1.7 (1.2-2.4) | 1.83 (1.26-2.65) | 1.10 (0.75-1.62) | 26 | 1.4 (1.0-2.1) | 1.79 (1.17-2.72) | 1.07 (0.70-1.65) |
Risk of myocardial infarction
Risk of stroke
Renal recovery
Recovery (n = 3,888) | Nonrecovery (n = 904) | |||
---|---|---|---|---|
Events | Adjusted HRb | Events | Adjusted HRb | |
n | (95%CI) | n | (95% CI) | |
AKI stage 1
| ||||
Heart failure | 98 | 1.26 (1.00-1.60) | 15 | 1.81 (1.07-3.07) |
Myocardial infarction | 35 | 1.05 (0.72-1.55) | 3 | 0.79 (0.25-2.51) |
Stroke | 32 | 1.142 (0.77-1.70) | 3 | 0.98 (0.31-3.10) |
AKI stages 2-3
| ||||
Heart failure | 62 | 1.50 (1.13-1.98) | 30 | 1.42 (0.96-2.10) |
Myocardial infarction | 23 | 1.31 (0.83-2.07) | 17 | 1.97 (1.17-3.32) |
Stroke | 19 | 1.16 (0.71-1.90) | 7 | 0.94 (0.43-2.04) |