Annals of Intensive Care (Mar 2023)

Long-term outcomes after severe acute kidney injury in critically ill patients: the SALTO study

  • Khalil Chaïbi,
  • Franck Ehooman,
  • Bertrand Pons,
  • Laurent Martin-Lefevre,
  • Eric Boulet,
  • Alexandre Boyer,
  • Guillaume Chevrel,
  • Nicolas Lerolle,
  • Dorothée Carpentier,
  • Nicolas de Prost,
  • Alexandre Lautrette,
  • Anne Bretagnol,
  • Julien Mayaux,
  • Saad Nseir,
  • Bruno Megarbane,
  • Marina Thirion,
  • Jean-Marie Forel,
  • Julien Maizel,
  • Hodane Yonis,
  • Philippe Markowicz,
  • Guillaume Thiery,
  • Frédérique Schortgen,
  • Cécile Couchoud,
  • Didier Dreyfuss,
  • Stephane Gaudry

DOI
https://doi.org/10.1186/s13613-023-01108-x
Journal volume & issue
Vol. 13, no. 1
pp. 1 – 11

Abstract

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Abstract Background The extent of the consequences of an episode of severe acute kidney injury (AKI) on long-term outcome of critically ill patients remain debated. We conducted a prospective follow-up of patients included in a large multicenter clinical trial of renal replacement therapy (RRT) initiation strategy during severe AKI (the Artificial Kidney Initiation in Kidney Injury, AKIKI) to investigate long-term survival, renal outcome and health related quality of life (HRQOL). We also assessed the influence of RRT initiation strategy on these outcomes. Results Follow-up of patients extended from 60 days to a median of 3.35 years [interquartile range (IQR), 1.89 to 4.09] after the end of initial study. Of the 619 patients included in the AKIKI trial, 316 survived after 60 days. The overall survival rate at 3 years from inclusion was 39.4% (95% CI 35.4 to 43.4). A total of 46 patients (on the 175 with available data on long-term kidney function) experienced worsening of renal function (WRF) at the time of follow-up [overall incidence of 26%, cumulative incidence at 4 years: 20.6% (CI 95% 13.0 to 28.3)]. Fifteen patients required chronic dialysis (5% of patients who survived after day 90). Among the 226 long-term survivors, 80 (35%) answered the EQ-5D questionnaire. The median index value reported was 0.67 (IQR 0.40 to 1.00) indicating a noticeable alteration of quality of life. Initiation strategy for RRT had no effect on any long-term outcome. Conclusion Severe AKI in critically ill patients was associated with a high proportion of death within the first 2 months but less so during long-term follow-up. A quarter of long-term survivors experienced a WRF and suffered from a noticeable impairment of quality of life. Renal replacement therapy initiation strategy was not associated with mortality outcome. Graphical Abstract

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