Risk progression system useful for determination of long-term kidney outcomes
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Applying a risk progression classification system to patients with a sepsis-associated kidney injury can aid nephrologists in predicting long-term kidney outcomes, results show.
“These data indicate acute kidney disease (AKD) status at discharge is an important clinical parameter of long-term kidney outcomes, and may serve as a measurable indictor of impaired/maladaptive kidney repair from sepsis-associated acute kidney infection (AKI) and contributor to the development of chronic kidney disease and kidney failure with replacement therapy (KFRT),” Alexander H. Flannery, Pharm D, FCCM, BCCCP, BCPS, of the department of pharmacy practice and science at the University of Kentucky College of Pharmacy, and colleagues wrote. “Accordingly, the hospital stay may be an important window of time to restore kidney function following sepsis-associated AKI.”
In this retrospective cohort study, Flannery and colleagues evaluated the long-term outcomes of adult patients who survived ICU admission for severe sepsis or septic shock and did not receive kidney replacement therapy up to 90 days following hospital discharge. A recent serum creatinine within 3 months of the ICU admission served as the baseline measure. The authors followed one cohort of 1,076 patients with AKI and another cohort of 1,231 patients who had no AKI for a median of 14.2 months. They categorized the stages of AKD by 0A, 0C or greater than or equal to 1. According to the authors, they created AKD staging using the ratio of the last serum creatinine divided by the baseline serum creatinine and used recommendations from the Acute Disease Quality Initiative workgroup on AKD and kidney recovery for categorization: less than 1.1 stage 0A AKD, greater than or equal to 1.1 to less than 1.5 stage 0C AKD and greater than or equal to 1.5 stage greater than or equal to 1 AKD.
Most patients received two serum creatinine measures during follow-up. Results revealed AKD stage at discharge or within 90 days was significantly associated with the composite of CKD incidence, progression, KFRT or death with worsening AKD stage linked with a progressively greater adjusted hazard ratio, according to Flannery and colleagues. They classified 53.1% of patients as stage 0A, 26.5% as stage 0C and 20.4% as greater than or equal to 1 AKD. The authors found stages 0C (adjusted hazard ratio [aHR] = 1.74) and greater than 1 AKD (aHR = 3.25) significantly associated with the outcome of CKD incidence, progression, KFRT or death following 90 days compared to stage 0A. Also, greater than or equal to 1 AKD carried more risk than stage 0C AKD (aHR = 1.87). CKD incidence or progression and KFRT occurred more frequently in higher stages of AKD.
“Our findings build on the importance of recovery of kidney function in sepsis-associated AKI, and to our knowledge, represent the first epidemiologic study of long-term outcomes in sepsis-associated AKI as assessed by the newly proposed AKD stage classification,” Flannery and colleagues wrote. “Given the high prevalence of AKD observed in survivors of sepsis-associated AKI in our study and prior work, the term sepsis-associated acute kidney disease (SA-AKD) appears worthy of its own classification given the impact on survivors of sepsis.”
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