Chronic Kidney Disease after Acute Kidney Injury Requiring Continuous Renal Replacement Therapy and Its Impact on Long-Term Outcomes: A Multicenter Retrospective Cohort Study in Korea

Jung Nam An, Jin Ho Hwang, Dong Ki Kim, Hajeong Lee, Shin Young Ahn, Sejoong Kim, Jung Tak Park, Shin Wook Kang, Yun Kyu Oh, Yon Su Kim, Chun Soo Lim, Hyung Jung Oh, Jung Pyo Lee

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: Severe acute kidney injury requiring continuous renal replacement therapy is associated with a high risk of early mortality. Our objectives were to identify a cohort of early survivors and to follow their renal progress and long-term mortality. Design: Multicenter, observational, retrospective cohort study. Setting: ICUs in tertiary academic hospitals in Korea. Patients: From 2009 to 2013, we identified 1,764 severe acute kidney injury patients who were started on continuous renal replacement therapy at four hospitals. Of these, we identified 331 survivors for whom we could identify renal function at baseline and at 3 months. Interventions: None. Measurements and Main Results: The 331 patients were separated into two groups based on their renal function at 3 months after the start of continuous renal replacement therapy. Those who displayed significant deterioration in renal function compared to baseline, defined as greater than or equal to 50% increase in serum creatinine or greater than or equal to 35% decrease in the estimated glomerular filtration rate, or those who continued to receive renal replacement therapy were designated as a "3-month chronic kidney disease progression" group. Those with a return to baseline, less than 50% increase in serum creatinine or less than 35% decrease in the estimated glomerular filtration rate, were designated as a "3-month chronic kidney disease nonprogression" group. The acute kidney injury patients requiring continuous renal replacement therapy showed a higher risk of progression to end-stage renal disease compared to that of stage 3 chronic kidney disease patients who did not undergo an acute kidney injury episode, even if the acute kidney injury was recovered at 3 months after continuous renal replacement therapy initiation. Furthermore, "3-month chronic kidney disease progression" was associated with a high risk of progression to end-stage renal disease and long-term mortality over a median follow-up period of 12.7 (3.8-33.2) and 20.4 (7.5-39.7) months, respectively. Older age, higher baseline serum creatinine levels, and higher blood urea nitrogen concentrations at continuous renal replacement therapy initiation, and lower 24-hour urine output after continuous renal replacement therapy initiation are associated with an increased risk of "3-month chronic kidney disease progression." Conclusions: Renal functional assessment at 3 months after continuous renal replacement therapy initiation can be useful in predicting progression to end-stage renal disease and long-term mortality. Furthermore, continuous close monitoring and management of acute kidney injury patients requiring continuous renal replacement therapy are required, even in those with recovered renal function.

Original languageEnglish
Pages (from-to)47-57
Number of pages11
JournalCritical Care Medicine
Volume45
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

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Renal Replacement Therapy
Korea
Chronic Renal Insufficiency
Acute Kidney Injury
Cohort Studies
Retrospective Studies
Kidney
Chronic Kidney Failure
Disease Progression
Creatinine
Mortality
Glomerular Filtration Rate
Survivors
Serum
Blood Urea Nitrogen
Tertiary Care Centers
Urine

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

An, Jung Nam ; Hwang, Jin Ho ; Kim, Dong Ki ; Lee, Hajeong ; Ahn, Shin Young ; Kim, Sejoong ; Park, Jung Tak ; Kang, Shin Wook ; Oh, Yun Kyu ; Kim, Yon Su ; Lim, Chun Soo ; Oh, Hyung Jung ; Lee, Jung Pyo. / Chronic Kidney Disease after Acute Kidney Injury Requiring Continuous Renal Replacement Therapy and Its Impact on Long-Term Outcomes : A Multicenter Retrospective Cohort Study in Korea. In: Critical Care Medicine. 2017 ; Vol. 45, No. 1. pp. 47-57.
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abstract = "Objectives: Severe acute kidney injury requiring continuous renal replacement therapy is associated with a high risk of early mortality. Our objectives were to identify a cohort of early survivors and to follow their renal progress and long-term mortality. Design: Multicenter, observational, retrospective cohort study. Setting: ICUs in tertiary academic hospitals in Korea. Patients: From 2009 to 2013, we identified 1,764 severe acute kidney injury patients who were started on continuous renal replacement therapy at four hospitals. Of these, we identified 331 survivors for whom we could identify renal function at baseline and at 3 months. Interventions: None. Measurements and Main Results: The 331 patients were separated into two groups based on their renal function at 3 months after the start of continuous renal replacement therapy. Those who displayed significant deterioration in renal function compared to baseline, defined as greater than or equal to 50{\%} increase in serum creatinine or greater than or equal to 35{\%} decrease in the estimated glomerular filtration rate, or those who continued to receive renal replacement therapy were designated as a {"}3-month chronic kidney disease progression{"} group. Those with a return to baseline, less than 50{\%} increase in serum creatinine or less than 35{\%} decrease in the estimated glomerular filtration rate, were designated as a {"}3-month chronic kidney disease nonprogression{"} group. The acute kidney injury patients requiring continuous renal replacement therapy showed a higher risk of progression to end-stage renal disease compared to that of stage 3 chronic kidney disease patients who did not undergo an acute kidney injury episode, even if the acute kidney injury was recovered at 3 months after continuous renal replacement therapy initiation. Furthermore, {"}3-month chronic kidney disease progression{"} was associated with a high risk of progression to end-stage renal disease and long-term mortality over a median follow-up period of 12.7 (3.8-33.2) and 20.4 (7.5-39.7) months, respectively. Older age, higher baseline serum creatinine levels, and higher blood urea nitrogen concentrations at continuous renal replacement therapy initiation, and lower 24-hour urine output after continuous renal replacement therapy initiation are associated with an increased risk of {"}3-month chronic kidney disease progression.{"} Conclusions: Renal functional assessment at 3 months after continuous renal replacement therapy initiation can be useful in predicting progression to end-stage renal disease and long-term mortality. Furthermore, continuous close monitoring and management of acute kidney injury patients requiring continuous renal replacement therapy are required, even in those with recovered renal function.",
author = "An, {Jung Nam} and Hwang, {Jin Ho} and Kim, {Dong Ki} and Hajeong Lee and Ahn, {Shin Young} and Sejoong Kim and Park, {Jung Tak} and Kang, {Shin Wook} and Oh, {Yun Kyu} and Kim, {Yon Su} and Lim, {Chun Soo} and Oh, {Hyung Jung} and Lee, {Jung Pyo}",
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Chronic Kidney Disease after Acute Kidney Injury Requiring Continuous Renal Replacement Therapy and Its Impact on Long-Term Outcomes : A Multicenter Retrospective Cohort Study in Korea. / An, Jung Nam; Hwang, Jin Ho; Kim, Dong Ki; Lee, Hajeong; Ahn, Shin Young; Kim, Sejoong; Park, Jung Tak; Kang, Shin Wook; Oh, Yun Kyu; Kim, Yon Su; Lim, Chun Soo; Oh, Hyung Jung; Lee, Jung Pyo.

In: Critical Care Medicine, Vol. 45, No. 1, 01.01.2017, p. 47-57.

Research output: Contribution to journalArticle

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T1 - Chronic Kidney Disease after Acute Kidney Injury Requiring Continuous Renal Replacement Therapy and Its Impact on Long-Term Outcomes

T2 - A Multicenter Retrospective Cohort Study in Korea

AU - An, Jung Nam

AU - Hwang, Jin Ho

AU - Kim, Dong Ki

AU - Lee, Hajeong

AU - Ahn, Shin Young

AU - Kim, Sejoong

AU - Park, Jung Tak

AU - Kang, Shin Wook

AU - Oh, Yun Kyu

AU - Kim, Yon Su

AU - Lim, Chun Soo

AU - Oh, Hyung Jung

AU - Lee, Jung Pyo

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: Severe acute kidney injury requiring continuous renal replacement therapy is associated with a high risk of early mortality. Our objectives were to identify a cohort of early survivors and to follow their renal progress and long-term mortality. Design: Multicenter, observational, retrospective cohort study. Setting: ICUs in tertiary academic hospitals in Korea. Patients: From 2009 to 2013, we identified 1,764 severe acute kidney injury patients who were started on continuous renal replacement therapy at four hospitals. Of these, we identified 331 survivors for whom we could identify renal function at baseline and at 3 months. Interventions: None. Measurements and Main Results: The 331 patients were separated into two groups based on their renal function at 3 months after the start of continuous renal replacement therapy. Those who displayed significant deterioration in renal function compared to baseline, defined as greater than or equal to 50% increase in serum creatinine or greater than or equal to 35% decrease in the estimated glomerular filtration rate, or those who continued to receive renal replacement therapy were designated as a "3-month chronic kidney disease progression" group. Those with a return to baseline, less than 50% increase in serum creatinine or less than 35% decrease in the estimated glomerular filtration rate, were designated as a "3-month chronic kidney disease nonprogression" group. The acute kidney injury patients requiring continuous renal replacement therapy showed a higher risk of progression to end-stage renal disease compared to that of stage 3 chronic kidney disease patients who did not undergo an acute kidney injury episode, even if the acute kidney injury was recovered at 3 months after continuous renal replacement therapy initiation. Furthermore, "3-month chronic kidney disease progression" was associated with a high risk of progression to end-stage renal disease and long-term mortality over a median follow-up period of 12.7 (3.8-33.2) and 20.4 (7.5-39.7) months, respectively. Older age, higher baseline serum creatinine levels, and higher blood urea nitrogen concentrations at continuous renal replacement therapy initiation, and lower 24-hour urine output after continuous renal replacement therapy initiation are associated with an increased risk of "3-month chronic kidney disease progression." Conclusions: Renal functional assessment at 3 months after continuous renal replacement therapy initiation can be useful in predicting progression to end-stage renal disease and long-term mortality. Furthermore, continuous close monitoring and management of acute kidney injury patients requiring continuous renal replacement therapy are required, even in those with recovered renal function.

AB - Objectives: Severe acute kidney injury requiring continuous renal replacement therapy is associated with a high risk of early mortality. Our objectives were to identify a cohort of early survivors and to follow their renal progress and long-term mortality. Design: Multicenter, observational, retrospective cohort study. Setting: ICUs in tertiary academic hospitals in Korea. Patients: From 2009 to 2013, we identified 1,764 severe acute kidney injury patients who were started on continuous renal replacement therapy at four hospitals. Of these, we identified 331 survivors for whom we could identify renal function at baseline and at 3 months. Interventions: None. Measurements and Main Results: The 331 patients were separated into two groups based on their renal function at 3 months after the start of continuous renal replacement therapy. Those who displayed significant deterioration in renal function compared to baseline, defined as greater than or equal to 50% increase in serum creatinine or greater than or equal to 35% decrease in the estimated glomerular filtration rate, or those who continued to receive renal replacement therapy were designated as a "3-month chronic kidney disease progression" group. Those with a return to baseline, less than 50% increase in serum creatinine or less than 35% decrease in the estimated glomerular filtration rate, were designated as a "3-month chronic kidney disease nonprogression" group. The acute kidney injury patients requiring continuous renal replacement therapy showed a higher risk of progression to end-stage renal disease compared to that of stage 3 chronic kidney disease patients who did not undergo an acute kidney injury episode, even if the acute kidney injury was recovered at 3 months after continuous renal replacement therapy initiation. Furthermore, "3-month chronic kidney disease progression" was associated with a high risk of progression to end-stage renal disease and long-term mortality over a median follow-up period of 12.7 (3.8-33.2) and 20.4 (7.5-39.7) months, respectively. Older age, higher baseline serum creatinine levels, and higher blood urea nitrogen concentrations at continuous renal replacement therapy initiation, and lower 24-hour urine output after continuous renal replacement therapy initiation are associated with an increased risk of "3-month chronic kidney disease progression." Conclusions: Renal functional assessment at 3 months after continuous renal replacement therapy initiation can be useful in predicting progression to end-stage renal disease and long-term mortality. Furthermore, continuous close monitoring and management of acute kidney injury patients requiring continuous renal replacement therapy are required, even in those with recovered renal function.

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