DOI QR코드

DOI QR Code

Duration of anuria predicts recovery of renal function after acute kidney injury requiring continuous renal replacement therapy

  • Jung, Hee-Yeon (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Lee, Jong-Hak (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Park, Young-Jae (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Kim, Sang-Un (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Lee, Kyung-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Choi, Ji-Young (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Park, Sun-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Kim, Chan-Duck (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Kim, Yong-Lim (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease) ;
  • Cho, Jang-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine, and Clinical Research Center for End Stage Renal Disease)
  • 투고 : 2014.09.25
  • 심사 : 2015.07.04
  • 발행 : 2016.09.01

초록

Background/Aims: Little is known regarding the incidence rate of and factors associated with developing chronic kidney disease after continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) patients. We investigated renal outcomes and the factors associated with incomplete renal recovery in AKI patients who received CRRT. Methods: Between January 2011 and November 2013, 408 patients received CRRT in our intensive care unit. Of them, patients who had normal renal function before AKI and were discharged without maintenance renal replacement therapy (RRT) were included in this study. We examined the incidence of incomplete renal recovery with an estimated glomerular filtration rate < $60mL/min/1.73m^2$ and factors that increased the risk of incomplete renal recovery after AKI. Results: In total, 56 AKI patients were discharged without further RRT and were followed for a mean of 8 months. Incomplete recovery of renal function was observed in 20 of the patients (35.7%). Multivariate analysis revealed old age and long duration of anuria as independent risk factors for incomplete renal recovery (odds ratio [OR], 1.231; 95% confidence interval [CI], 1.041 to 1.457; p = 0.015 and OR, 1.064; 95% CI, 1.001 to 1.131; p = 0.047, respectively). In a receiver operating characteristic curve analysis, a cut-off anuria duration of 24 hours could predict incomplete renal recovery after AKI with a sensitivity of 85.0% and a specificity of 66.7%. Conclusions: The renal outcome of severe AKI requiring CRRT was poor even in patients without further RRT. Long-term monitoring of renal function is needed, especially in severe AKI patients who are old and have a long duration of anuria.

키워드

과제정보

연구 과제 주관 기관 : Biomedical Research Institute, Kyungpook National University Hospital

참고문헌

  1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure: definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-R212. https://doi.org/10.1186/cc2872
  2. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31. https://doi.org/10.1186/cc5713
  3. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813-818. https://doi.org/10.1001/jama.294.7.813
  4. Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 2009;20:223-228. https://doi.org/10.1681/ASN.2007080837
  5. Wald R, Quinn RR, Luo J, et al. Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 2009;302:1179-1185. https://doi.org/10.1001/jama.2009.1322
  6. Pannu N, James M, Hemmelgarn B, Klarenbach S; Alberta Kidney Disease Network. Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol 2013;8:194-202. https://doi.org/10.2215/CJN.06480612
  7. Hsu CY, Ordonez JD, Chertow GM, Fan D, McCulloch CE, Go AS. The risk of acute renal failure in patients with chronic kidney disease. Kidney Int 2008;74:101-107. https://doi.org/10.1038/ki.2008.107
  8. Swets JA. Measuring the accuracy of diagnostic systems. Science 1988;240:1285-1293. https://doi.org/10.1126/science.3287615
  9. Hsu CY, McCulloch CE, Fan D, Ordonez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int 2007;72:208-212. https://doi.org/10.1038/sj.ki.5002297
  10. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Temporal changes in incidence of dialysis-requiring AKI. J Am Soc Nephrol 2013;24:37-42. https://doi.org/10.1681/ASN.2012080800
  11. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012;81:442-448. https://doi.org/10.1038/ki.2011.379
  12. Jones J, Holmen J, De Graauw J, Jovanovich A, Thornton S, Chonchol M. Association of complete recovery from acute kidney injury with incident CKD stage 3 and allcause mortality. Am J Kidney Dis 2012;60:402-408. https://doi.org/10.1053/j.ajkd.2012.03.014
  13. Rifkin DE, Coca SG, Kalantar-Zadeh K. Does AKI truly lead to CKD? J Am Soc Nephrol 2012;23:979-984. https://doi.org/10.1681/ASN.2011121185
  14. Schmitt R, Coca S, Kanbay M, Tinetti ME, Cantley LG, Parikh CR. Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 2008;52:262-271. https://doi.org/10.1053/j.ajkd.2008.03.005
  15. Schiffl H. Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. Nephrol Dial Transplant 2006;21:1248-1252. https://doi.org/10.1093/ndt/gfk069
  16. Allegretti AS, Steele DJ, David-Kasdan JA, Bajwa E, Niles JL, Bhan I. Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study. Crit Care 2013;17:R109. https://doi.org/10.1186/cc12780
  17. Mehta RL, McDonald B, Gabbai FB, et al. A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 2001;60:1154-1163. https://doi.org/10.1046/j.1523-1755.2001.0600031154.x
  18. Uehlinger DE, Jakob SM, Ferrari P, et al. Comparison of continuous and intermittent renal replacement therapy for acute renal failure. Nephrol Dial Transplant 2005;20:1630-1637. https://doi.org/10.1093/ndt/gfh880
  19. Ng KP, Chanouzas D, Fallouh B, Baharani J. Short and long-term outcome of patients with severe acute kidney injury requiring renal replacement therapy. QJM 2012;105:33-39. https://doi.org/10.1093/qjmed/hcr133
  20. Augustine JJ, Sandy D, Seifert TH, Paganini EP. A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 2004;44:1000-1007. https://doi.org/10.1053/j.ajkd.2004.08.022
  21. Suzuki H, Kanno Y, Kaneko K, et al. Comparison of the effects of angiotensin receptor antagonist, angiotensin converting enzyme inhibitor, and their combination on regression of left ventricular hypertrophy of diabetes type 2 patients on recent onset hemodialysis therapy. Ther Apher Dial 2004;8:320-327. https://doi.org/10.1111/j.1526-0968.2004.00142.x
  22. Oh HJ, Shin DH, Lee MJ, et al. Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy. J Crit Care 2013;28:379-388. https://doi.org/10.1016/j.jcrc.2012.11.019
  23. Wu VC, Ko WJ, Chang HW, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med 2008;34:101-108. https://doi.org/10.1007/s00134-007-0813-x
  24. Uchino S, Bellomo R, Morimatsu H, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med 2009;37:2576-2582. https://doi.org/10.1097/CCM.0b013e3181a38241
  25. Heise D, Gries D, Moerer O, Bleckmann A, Quintel M. Predicting restoration of kidney function during CRRT-free intervals. J Cardiothorac Surg 2012;7:6. https://doi.org/10.1186/1749-8090-7-6
  26. Pinsky MR, Brophy P, Padilla J, Paganini E, Pannu N. Fluid and volume monitoring. Int J Artif Organs 2008;31:111-126. https://doi.org/10.1177/039139880803100205
  27. Bagshaw SM, Bellomo R, Kellum JA. Oliguria, volume overload, and loop diuretics. Crit Care Med 2008;36(4 Suppl):S172-S178. https://doi.org/10.1097/CCM.0b013e318168c92f
  28. Avila MO, Zanetta DM, Abdulkader RC, Yu L, Burdmann EA. Urine volume in acute kidney injury: how much is enough? Ren Fail 2009;31:884-890. https://doi.org/10.3109/08860220903216089
  29. Myers BD, Moran SM. Hemodynamically mediated acute renal failure. N Engl J Med 1986;314:97-105. https://doi.org/10.1056/NEJM198601093140207
  30. Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 2011;79:1361-1369. https://doi.org/10.1038/ki.2011.42

피인용 문헌

  1. Clinical evaluation of acute kidney injury in Al-Zahraa University Hospital, Cairo, Egypt vol.29, pp.None, 2017, https://doi.org/10.4103/ejim.ejim_3_17
  2. Knowledge towards Chronic Kidney Disease Manifestations in Saudi Arabia vol.8, pp.11, 2016, https://doi.org/10.4236/ojpm.2018.811027
  3. Recovery of renal function in a heart transplantation recipient with over 300 days of iatrogenic anuria : A case report vol.97, pp.17, 2018, https://doi.org/10.1097/md.0000000000010451
  4. Urine Neutrophil Gelatinase-Associated Lipocalin Measured at Admission to Predict Recovery from Acute Kidney Injury of Vietnamese ICU Patients vol.12, pp.1, 2016, https://doi.org/10.2174/1874303x01912010060