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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

Title
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
Authors
An, Jung NamHwang, Jin HoKim, Dong KiLee, HajeongAhn, Shin YoungKim, SejoongPark, Jung TakKang, Shin-WookOh, Yun KyuKim, Yon SuLim, Chun SooOh, Hyung JungLee, Jung Pyo
Ewha Authors
오형중
SCOPUS Author ID
오형중scopus
Issue Date
2017
Journal Title
CRITICAL CARE MEDICINE
ISSN
0090-3493JCR Link

1530-0293JCR Link
Citation
CRITICAL CARE MEDICINE vol. 45, no. 1, pp. 47 - 57
Keywords
acute kidney injurychronic kidney diseasecontinuous renal replacement therapylong-term outcomes
Publisher
LIPPINCOTT WILLIAMS &

WILKINS
Indexed
SCIE; SCOPUS WOS
Document Type
Article
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.
DOI
10.1097/CCM.0000000000002012
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의료원 > 의료원 > Journal papers
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