Outcomes of severe acute kidney injury - what's new?

Abstract

Introduction Despite improvements in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise. The aim of our study was to analyse the changes during 15 years period in etiology, incidence and outcomes of severe AKI, which required dialysis, in a large single centre. Methods We performed retrospective analysis of all patients (n=3576) with severe AKI hospitalized and dialysed in the Lithuanian Health Sciences University Kaunas Clinic (LHSU KC) during period of 1998 – 2012. Analysing our data, we used AKIN criteria. Patients, who received some kind of renal replacement therapy, were classified as AKI3. Results During 15 years period the incidence of severe AKI increased from 96 till 597 cases /p.m.p. The mean age of patients was 62.5±17.2 years and increased from 55.4 years in 1998 to 65.7 years in 2012. During the investigated period it was observed significant increase in the number of patients older than 80 years (in 1998-2002 years period they composed 3.8% and in 2008-2012 – 15.3% of all patients). The number of men with severe AKI (n=2238, 62.6%) was significantly higher than that of women (n=1337, 37.4%). The causes of severe AKI were renal (n=1227, 35.5%), prerenal (n=690, 20%), obstructive (n=330, 9.5%) and in 12.1% of patients causes were polietiological. During 15 years period the number of polietiological severe AKI increased from 5.1% in 1998-2002 years period to 14.3% in 2008-2012. Overall the most frequent cause of AKI was acute tubular necrosis (n=1154, 33.4%). It was no significant difference in the outcomes of severe AKI during the investigated period, only in the period of 2003–2007 and 2008–2012 more patients remained dialysis dependent if compare to the period of 1998–2002. The renal replacement therapy (RRT) was discontinued because of recovery of renal function in 45.7% of cases. 7.7% of patients remained dialysis dependent. The mortali