Introduction:
Acute kidney injury (AKI) is common in hospitalized patients and linked to higher morbidity and mortality. Many studies examining long-term outcomes post-AKI rely on administrative databases lacking direct patient data. This study aimed to evaluate long-term survival and kidney outcomes in AKI patients, hypothesizing that they would have poor long-term prognoses.
Methods:
We analyzed data of adult AKI patients admitted to the University of Virginia Medical Center between January 1, 2001, and December 31, 2015. Overall survival was assessed during long-term follow-up post admission. Chronic kidney disease (CKD) is defined as persistent kidney disease lasting over 90 days, so renal outcomes were evaluated after this period. Worsening renal function (WRF) was determined by CKD status at baseline: for patients without CKD, WRF was identified by progression from stages 1 or 2 to stages 3, 4, or 5; for those with CKD, it was indicated by progression from stage 3 to stages 4 or 5.
Results:
A total of 11,835 patients experienced an episode of AKI during their initial admission. The median length of follow up was 27.1 months (6.1 – 69.0 months). Participants had an average age of 62.41 years (SD = ±15.52). The mean baseline serum creatinine level was 1.33 mg/dL (SD = ±0.78), and the mean Charlson comorbidity index score was 4.13 (SD = ±3.21). Common comorbidities included diabetes mellitus (40.6%), congestive heart failure (39.7%), cancer (31.4%), and pneumonia (22.7%). Additionally, 25.3% required mechanical ventilation. Eighty-five percent had stage 1, 10.2% had stage 2, and 4.8% had stage 3 AKI. Overall survival rate was 63.6%, 49.7%, 38% and 30.4% at 3 months, 1 year, 2 years and 3 years from inclusion, respectively. A total of 69 patients (19.3%) of the 358 with available data on long-term kidney function) experienced worsening of renal function (WRF) at the time of follow-up (overall incidence of 11.9%). One thousand one hundred and fifteen patients required chronic dialysis (9.6% of patients who survived after day 90). Kaplan-Meier survival revealed that survival was significantly better in non-dialytic patients than dialytic patients (p ≤ 0.001).
Conclusions:
AKI in hospitalised patients was associated with a high proportion of death within the first 1 year but less so during long-term follow-up. Initiation of dialysis was associated with poor mortality outcome among those that received dialysis.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.