Evaluation of "loss" and "end stage renal disease" after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients

Rodrigo Cartin-Ceba, Eric N. Haugen, Remzi Iscimen, Cesar Trillo-Alvarez, Luis Juncos, Ognjen Gajic

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Purpose: The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the definition of acute kidney injury (AKI); however, no study has described in detail the last two stages of the classification: "Loss" and "ESRD". We aim to describe and evaluate the development of "Loss" and "ESRD" in a group of critically ill patients. Methods: We conducted a retrospective analysis of cases prospectively collected from the Acute Physiology and Chronic Health Assessment (APACHE III) database. Subjects were consecutive critically ill patients >18 years of age admitted to three ICUs of two tertiary care academic hospitals, from January 2003 through August 2006, excluding those who denied research authorization, chronic hemodialysis therapy, kidney transplant recipients, readmissions, and admissions for less than 12 h for low risk monitoring. Results: 11,644 patients were included in the study. The median age was 66 (interquartile range, 52-76), 90% were Caucasians and 54% of the patients were male. Half of the patients developed AKI, and most of the patients were in the Risk and Injury stages. From the patients that developed AKI, a total of 1,065 (19%) patients required renal replacement therapy (RRT), 415 (39%) underwent continuous renal replacement therapy (CRRT) and 650 (61%) underwent intermittent hemodialysis. A total of 281 patients on RRT did not survive hospital discharge, 97 patients progressed to "Loss", and 282 patients progressed to "ESRD". After multivariable adjustment, the progression to "ESRD" was associated with higher baseline creatinine, odds ratio (OR) 1.19 per every increase in creatinine of 0.1 mg/dl (95% CI, 1.11-1.29) P < 0.001; and less frequent use of CRRT, OR 0.18 (95% CI, 0.11-0.29) P < 0.001. Conclusion: In this large retrospective study we found that almost 50% developed some form of AKI as defined by the RIFLE classification. Of these, 19% required RRT, and 4.9% progressed to "ESRD". "ESRD" was more likely in patients with elevated baseline creatinine and those treated with intermittent hemodialysis.

Original languageEnglish (US)
Pages (from-to)2087-2095
Number of pages9
JournalIntensive Care Medicine
Volume35
Issue number12
DOIs
StatePublished - Dec 2009

Fingerprint

Acute Kidney Injury
Critical Illness
Chronic Kidney Failure
Wounds and Injuries
Renal Replacement Therapy
Renal Dialysis
Creatinine
Odds Ratio
APACHE
Patient Discharge
Tertiary Healthcare
Retrospective Studies
Databases
Kidney
Health

Keywords

  • Acute kidney injury
  • Creatinine
  • Intensive care unit
  • Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Evaluation of "loss" and "end stage renal disease" after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients. / Cartin-Ceba, Rodrigo; Haugen, Eric N.; Iscimen, Remzi; Trillo-Alvarez, Cesar; Juncos, Luis; Gajic, Ognjen.

In: Intensive Care Medicine, Vol. 35, No. 12, 12.2009, p. 2087-2095.

Research output: Contribution to journalArticle

Cartin-Ceba, Rodrigo ; Haugen, Eric N. ; Iscimen, Remzi ; Trillo-Alvarez, Cesar ; Juncos, Luis ; Gajic, Ognjen. / Evaluation of "loss" and "end stage renal disease" after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients. In: Intensive Care Medicine. 2009 ; Vol. 35, No. 12. pp. 2087-2095.
@article{2e63a2213f5e4a33b049b7f15ee4f9ac,
title = "Evaluation of {"}loss{"} and {"}end stage renal disease{"} after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients",
abstract = "Purpose: The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the definition of acute kidney injury (AKI); however, no study has described in detail the last two stages of the classification: {"}Loss{"} and {"}ESRD{"}. We aim to describe and evaluate the development of {"}Loss{"} and {"}ESRD{"} in a group of critically ill patients. Methods: We conducted a retrospective analysis of cases prospectively collected from the Acute Physiology and Chronic Health Assessment (APACHE III) database. Subjects were consecutive critically ill patients >18 years of age admitted to three ICUs of two tertiary care academic hospitals, from January 2003 through August 2006, excluding those who denied research authorization, chronic hemodialysis therapy, kidney transplant recipients, readmissions, and admissions for less than 12 h for low risk monitoring. Results: 11,644 patients were included in the study. The median age was 66 (interquartile range, 52-76), 90{\%} were Caucasians and 54{\%} of the patients were male. Half of the patients developed AKI, and most of the patients were in the Risk and Injury stages. From the patients that developed AKI, a total of 1,065 (19{\%}) patients required renal replacement therapy (RRT), 415 (39{\%}) underwent continuous renal replacement therapy (CRRT) and 650 (61{\%}) underwent intermittent hemodialysis. A total of 281 patients on RRT did not survive hospital discharge, 97 patients progressed to {"}Loss{"}, and 282 patients progressed to {"}ESRD{"}. After multivariable adjustment, the progression to {"}ESRD{"} was associated with higher baseline creatinine, odds ratio (OR) 1.19 per every increase in creatinine of 0.1 mg/dl (95{\%} CI, 1.11-1.29) P < 0.001; and less frequent use of CRRT, OR 0.18 (95{\%} CI, 0.11-0.29) P < 0.001. Conclusion: In this large retrospective study we found that almost 50{\%} developed some form of AKI as defined by the RIFLE classification. Of these, 19{\%} required RRT, and 4.9{\%} progressed to {"}ESRD{"}. {"}ESRD{"} was more likely in patients with elevated baseline creatinine and those treated with intermittent hemodialysis.",
keywords = "Acute kidney injury, Creatinine, Intensive care unit, Mortality",
author = "Rodrigo Cartin-Ceba and Haugen, {Eric N.} and Remzi Iscimen and Cesar Trillo-Alvarez and Luis Juncos and Ognjen Gajic",
year = "2009",
month = "12",
doi = "10.1007/s00134-009-1635-9",
language = "English (US)",
volume = "35",
pages = "2087--2095",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "12",

}

TY - JOUR

T1 - Evaluation of "loss" and "end stage renal disease" after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients

AU - Cartin-Ceba, Rodrigo

AU - Haugen, Eric N.

AU - Iscimen, Remzi

AU - Trillo-Alvarez, Cesar

AU - Juncos, Luis

AU - Gajic, Ognjen

PY - 2009/12

Y1 - 2009/12

N2 - Purpose: The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the definition of acute kidney injury (AKI); however, no study has described in detail the last two stages of the classification: "Loss" and "ESRD". We aim to describe and evaluate the development of "Loss" and "ESRD" in a group of critically ill patients. Methods: We conducted a retrospective analysis of cases prospectively collected from the Acute Physiology and Chronic Health Assessment (APACHE III) database. Subjects were consecutive critically ill patients >18 years of age admitted to three ICUs of two tertiary care academic hospitals, from January 2003 through August 2006, excluding those who denied research authorization, chronic hemodialysis therapy, kidney transplant recipients, readmissions, and admissions for less than 12 h for low risk monitoring. Results: 11,644 patients were included in the study. The median age was 66 (interquartile range, 52-76), 90% were Caucasians and 54% of the patients were male. Half of the patients developed AKI, and most of the patients were in the Risk and Injury stages. From the patients that developed AKI, a total of 1,065 (19%) patients required renal replacement therapy (RRT), 415 (39%) underwent continuous renal replacement therapy (CRRT) and 650 (61%) underwent intermittent hemodialysis. A total of 281 patients on RRT did not survive hospital discharge, 97 patients progressed to "Loss", and 282 patients progressed to "ESRD". After multivariable adjustment, the progression to "ESRD" was associated with higher baseline creatinine, odds ratio (OR) 1.19 per every increase in creatinine of 0.1 mg/dl (95% CI, 1.11-1.29) P < 0.001; and less frequent use of CRRT, OR 0.18 (95% CI, 0.11-0.29) P < 0.001. Conclusion: In this large retrospective study we found that almost 50% developed some form of AKI as defined by the RIFLE classification. Of these, 19% required RRT, and 4.9% progressed to "ESRD". "ESRD" was more likely in patients with elevated baseline creatinine and those treated with intermittent hemodialysis.

AB - Purpose: The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the definition of acute kidney injury (AKI); however, no study has described in detail the last two stages of the classification: "Loss" and "ESRD". We aim to describe and evaluate the development of "Loss" and "ESRD" in a group of critically ill patients. Methods: We conducted a retrospective analysis of cases prospectively collected from the Acute Physiology and Chronic Health Assessment (APACHE III) database. Subjects were consecutive critically ill patients >18 years of age admitted to three ICUs of two tertiary care academic hospitals, from January 2003 through August 2006, excluding those who denied research authorization, chronic hemodialysis therapy, kidney transplant recipients, readmissions, and admissions for less than 12 h for low risk monitoring. Results: 11,644 patients were included in the study. The median age was 66 (interquartile range, 52-76), 90% were Caucasians and 54% of the patients were male. Half of the patients developed AKI, and most of the patients were in the Risk and Injury stages. From the patients that developed AKI, a total of 1,065 (19%) patients required renal replacement therapy (RRT), 415 (39%) underwent continuous renal replacement therapy (CRRT) and 650 (61%) underwent intermittent hemodialysis. A total of 281 patients on RRT did not survive hospital discharge, 97 patients progressed to "Loss", and 282 patients progressed to "ESRD". After multivariable adjustment, the progression to "ESRD" was associated with higher baseline creatinine, odds ratio (OR) 1.19 per every increase in creatinine of 0.1 mg/dl (95% CI, 1.11-1.29) P < 0.001; and less frequent use of CRRT, OR 0.18 (95% CI, 0.11-0.29) P < 0.001. Conclusion: In this large retrospective study we found that almost 50% developed some form of AKI as defined by the RIFLE classification. Of these, 19% required RRT, and 4.9% progressed to "ESRD". "ESRD" was more likely in patients with elevated baseline creatinine and those treated with intermittent hemodialysis.

KW - Acute kidney injury

KW - Creatinine

KW - Intensive care unit

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=70849137208&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70849137208&partnerID=8YFLogxK

U2 - 10.1007/s00134-009-1635-9

DO - 10.1007/s00134-009-1635-9

M3 - Article

C2 - 19756503

AN - SCOPUS:70849137208

VL - 35

SP - 2087

EP - 2095

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 12

ER -