Sepsis-associated acute kidney injury in patients with chronic kidney disease: Patient characteristics, prevalence, timing, trajectory, treatment and associated outcomes.

Autor:	White KC; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.; Queensland University of Technology (QUT), Brisbane, Queensland, Australia., Bellomo R; Department of Intensive Care, Austin Hospital, Heidelberg, Australia.; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Critical Care, University of Melbourne, Melbourne, Australia.; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia., Tabah A; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.; Intensive Care Unit, Redcliffe Hospital, Brisbane, Queensland, Australia., Attokaran AG; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.; Intensive Care Unit, Rockhampton Hospital, Queensland, Australia., White H; Intensive Care Unit, Logan Hospital, Queensland, Australia.; School of Medicine and Dentistry, Griffith University, Queensland, Australia., McCullough J; School of Medicine and Dentistry, Griffith University, Queensland, Australia.; Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia., Shekar K; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia., Ramanan M; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.; Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia.; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia., Garrett P; School of Medicine and Dentistry, Griffith University, Queensland, Australia.; Intensive Care Unit, Sunshine Coast University Hospital, Queensland, Australia., McIlroy P; Intensive Care Unit, Cairns Hospital, Cairns, Queensland, Australia., Senthuran S; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.; Intensive Care Unit, Townsville Hospital, Townsville, Queensland, Australia., Luke S; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.; Intensive Care Services, Mackay Base Hospital, Mackay, Queensland, Australia., Serpa-Neto A; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil., Larsen T; Department of Critical Care, University of Melbourne, Melbourne, Australia.; Data Analytics Research and Evaluation (DARE) Centre, Austin Health and the University of Melbourne, Victoria, Australia., Laupland KB; Queensland University of Technology (QUT), Brisbane, Queensland, Australia.; Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Jazyk:	angličtina
Zdroj:	Nephrology (Carlton, Vic.) [Nephrology (Carlton)] 2024 Sep 18. Date of Electronic Publication: 2024 Sep 18.
DOI:	10.1111/nep.14392
Abstrakt:	Aim: The features and outcomes of sepsis-associated acute kidney injury (SA-AKI) may be affected by chronic kidney disease (CKD). Accordingly, we aimed to compare SA-AKI in patients with or without CKD. Methods: Retrospective cohort study in 12 intensive care units (ICU). We studied the prevalence, patient characteristics, timing, trajectory, treatment and outcomes of SA-AKI with and without CKD. Results: Of 84 240 admissions, 7255 (8.6%) involved patients with CKD. SA-AKI was more common in patients with CKD (21% vs 14%; p < .001). CKD patients were older (70 vs. 60 years; p < .001), had a higher median Charlson co-morbidity index (5 vs. 3; p < .001) and acute physiology and chronic health evaluation (APACHE) III score (78 vs. 60; p < .001) and were more likely to receive renal replacement therapy (RRT) (25% vs. 17%; p < .001). They had less complete return to baseline function at ICU discharge (48% vs. 60%; p < .001), higher major adverse kidney events at day 30 (MAKE-30) (38% vs. 27%; p < .001), and higher hospital and 90-day mortality (21% vs. 13%; p < .001, and 27% vs. 16%; p < .001, respectively). After adjustment for patient characteristics and severity of illness, however, CKD was not an independent risk factor for increased 90-day mortality (OR 0.88; 95% CI 0.76-1.02; p = .08) or MAKE-30 (OR 0.98; 95% CI 0.80-1.09; p = .4). Conclusion: SA-AKI is more common in patients with CKD. Such patients are older, more co-morbid, have higher disease severity, receive different ICU therapies and have different trajectories of renal recovery and greater unadjusted mortality. However, after adjustment day-90 mortality and MAKE-30 risk were not increased by CKD. (© 2024 The Author(s). Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology.)
Databáze:	MEDLINE
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