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NDT Advance Access published online on February 19, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp072
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Long-term prognosis after acute kidney injury requiring renal replacement therapy

Pierre-Alain Triverio1, Pierre-Yves Martin1, Jacques Romand2, Jerome Pugin2, Thomas Perneger3 and Patrick Saudan1

1 Service de Néphrologie 2 Services des Soins Intensifs de Chirurgie et de Médecine 3 Groupe Qualité, Hôpitaux Universitaires de Genève, Geneva, Switzerland

Correspondence and offprint requests to: Patrick Saudan, Division of Nephrology, University Hospital, 1211 Geneva 14, Switzerland. Tel: +41-22-3726794; Fax: +41-22-3726794; E-mail: Patrick.Saudan{at}hcuge.ch



  Abstract

Background. Data on the long-term survival and renal function of patients with acute kidney injury (AKI) treated with continuous renal replacement therapy are scarce.

Methods. We investigated the 3-year survival and need for chronic dialysis in critically ill patients, who had survived an episode of AKI requiring continuous renal replacement therapy.

Results. A total of 206 ICU patients with AKI were randomized in a trial comparing haemofiltration versus haemodiafiltration. Of these, 95 (46%) survived at 90 days. Post-discharge information relating to 3-year survival and renal function was successfully obtained in 89 (94%) of the patients. Of the 89 patients studied, chronic kidney disease (CKD) was present in 32 subjects from the onset, and CKD developed de novo in 25 patients following AKI. End-stage renal disease (ESRD) developed in 9 patients (of whom 8 had pre-existing CKD) and 29 patients died. Three-year survival was 67% overall; the mortality at 3 years was 50% for those with pre-existing kidney disease, and 71 and 82% for those with de novo and without CKD, respectively.

Conclusion. After an episode of AKI necessitating a continuous renal replacement therapy, rapid progression to ESKD is commonly observed in patients with pre-existing chronic renal impairment. Medical care with an emphasis on nephroprotection is necessary in these patients.

Keywords: acute kidney injury; continuous renal replacement therapy; long-term survival

Received for publication: 16.10.07
Accepted in revised form: 2. 2.09


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