Mortality prediction in patients with severe dialysis - dependent acute kidney injury : [pranešimas žurnale]

Abstract

INTRODUCTION. Despite improvements in the quality of medical care, the incidence and mortality of acute kidney injury (AKI) continues to rise. Every year about 2 mln. people worldwide die due to AKI. Such high mortality persists for already several decades, and stimulates to search for the possibilities to reduce it. OBJECTIVES. The aim of our study was to establish the predictive factors of mortality of the patients with severe dialysis - dependent AKI (stage 3). METHODS. Single-centre of the largest university Lithuanian hospital Kaunas Clinics within a 2-year period retrospective pilot study was carried out. Inclusion criteria: 1) severe dialysis - dependent AKI stage 3; 2) age ≥ 18. RESULTS. In 573 patients hospital mortality was found to be 51.7% (n=296). For 32.5% (n=186) of the investigated patients the renal function improved, and almost 16% (n=91) of patients remained dialysis - dependent after their discharge from the hospital. Significant prognostic factors of mortality were found to be: age > 85 years (OR 2.356, 95% CI [1.105-5.021], p=0.026), chronic kidney disease before AKI (OR 1.734, 95% CI [1.121-2.682], p=0.013), AKI after a cardiosurgery (OR 3.358, 95% CI [1.564-7.210], p=0.002), sepsis (OR 3.048, 95% CI [2.128 - 4.367] p< 0.001), requirement of vasopressors (OR 17.164, 95% CI [11.306 - 26.056], p< 0.001), mechanical ventilation (OR 7.732, 95% CI [5.268 - 11.350], p < 0.001), administration of aminoglycosides (OR 2.402, 95% CI [1.345 - 4.291], p=0.003), oliguria (OR 3.504, 95% CI [2.430 - 5.054], p< 0.001), alveolar pulmonary oedema (OR 2.018, 95% CI [1.391 - 2.926], p< 0.001), systolic blood pressure (BP) ≤ 120 mmHg (OR 8.452, 95% CI [5.784 - 12.352], p< 0.001), diastolic BP ≤ 65 mmHg (OR 5.892, 95% CI [4.099 - 8.470], p< 0.001), SOFA score ≥ 7.5 (OR 13.149, 95% CI [8.812 - 19.619], p< 0.001), serum sodium > 140 mmol/l (OR 2.206, [...].