The relationship of KDIGO classification and incidence & mortality of acute kidney injury in sepsis patients in intensive care unit: A retrospective cohort study
Acute kidney injury in sepsis patients in ICU
Keywords:acute renal injury, critical care, KDIGO, mortality
Background/Aim: Acute kidney injury (AKI) is a common and serious complication associated with morbidity and mortality in patients with sepsis. This study aimed to determine the severity of AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and evaluate its relationship with mortality in patients who were followed up in the intensive care unit (ICU) due to sepsis and developed AKI.
Methods: We retrospectively analyzed patients diagnosed with sepsis and followed up in the ICU, including all patients with AKI. The severity of AKI was determined for all patients using the KDIGO criteria. The patients were divided into four groups: Stage 1, Stage 2, Stage 3, and without AKI. Patients with missing data, COVID-19 patients, patients with chronic kidney insufficiency, and kidney transplant patients were excluded.
Results: A total of 1,177 sepsis patients were included in the study, of whom 52.4% were male (n=617). The median age of the study group was 78 years (Q1-Q3: 68-85 years). It was determined that 57.9% of the patients (n=681) developed AKI at any stage. According to the KDIGO criteria, the rates of patients in Stage 1, Stage 2, and Stage 3 developing AKI were 23.9%, 16.2%, and 17.8%, respectively. The incidence of hypertension (HT) and diabetes mellitus (DM), which are comorbidities, increased as the patients’ KDIGO stage increased (P<0.001).
Conclusion: AKI occurred in 57.9% of sepsis patients in the ICU, and 30.4% received renal replacement therapy (RRT). It was determined that mortality increased as the KDIGO stage of our patients increased.
Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-23. DOI: https://doi.org/10.1007/s00134-015-3934-7
Griffin BR, Liu KD, Teixeira JP. Critical Care Nephrology: Core Curriculum 2020. Am J Kidney Dis. 2020;75(3):435-52. DOI: https://doi.org/10.1053/j.ajkd.2019.10.010
Mas-Font S, Ros-Martinez J, Pérez-Calvo C, Villa-Díaz P, Aldunate-Calvo S, Moreno-Clari E; on belhaf of the Workgroup on Nephrology Intensive Care of the SEMICYUC. Prevention of acute kidney injury in Intensive Care Units. Med Intensiva. 2017;41(2):116-26. DOI: https://doi.org/10.1016/j.medin.2016.12.004
Bellomo R, Kellum JA, Ronco C, Wald R, Martensson J, Maiden M, et al. Acute kidney injury in sepsis. Intensive Care Med. 2017;43(6):816-28. DOI: https://doi.org/10.1007/s00134-017-4755-7
Ostermann M, Bellomo R, Burdmann EA, Doi K, Endre ZH, Goldstein SL, et al. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int. 2020;98(2):294-309. DOI: https://doi.org/10.1016/j.kint.2020.04.020
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney İnjury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int. 2012;2:1-138.
Kellum JA, Romagnani P, Ashuntantang G, Ronco C, Zarbock A, Anders HJ. Acute kidney injury. Nat Rev Dis Primers. 2021;7(1):52. DOI: https://doi.org/10.1038/s41572-021-00284-z
Zarbock A, Nadim MK, Pickkers P, Gomez H, Bell S, Joannidis M, et al. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol. 2023;19(6):401-17. DOI: https://doi.org/10.1038/s41581-023-00683-3
Peerapornratana S, Manrique-Caballero CL, Gomez H, Kellum JA. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019;96:1083-99. DOI: https://doi.org/10.1016/j.kint.2019.05.026
Fonseca Ruiz NJ, Castro DP, Guerra AM, Saldarriaga FM, Hernández JD. Renal injury study in critical ill patients in accordance with the new definition given by the Acute Kidney Injury Network. J Crit Care. 2011;26(2):206-12. DOI: https://doi.org/10.1016/j.jcrc.2010.06.011
Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X; Beijing Acute Kidney Injury Trial (BAKIT) workgroup. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Crit Care. 2014;18(4):144. DOI: https://doi.org/10.1186/cc13977
Bayrakçı N, Ersan S, Çelik A, Çavdar C, Çamsarı T, Bodur HA, et al. The Role of RIFLE, AKIN and KDIGO Criteria in Determining the Relationship Between Acute Kidney Injury and Mortality in Intensive Care Patients. Namik Kemal Med J. 2022;10:37-42. DOI: https://doi.org/10.4274/nkmj.galenos.2021.29964
Srisawat N, Sileanu FE, Murugan R, Bellomod R, Calzavacca P, Cartin-Ceba R, et al; Acute Kidney Injury-6 Study Group. Variation in risk and mortality of acute kidney injury in critically ill patients: a multicenter study. Am J Nephrol. 2015;41(1):81-8. DOI: https://doi.org/10.1159/000371748
Peng Q, Zhang L, Ai Y, Zhang L. Epidemiology of acute kidney injury in intensive care septic patients based on the KDIGO guidelines. Chin Med J (Engl). 2014;127(10):1820-6.
Rodrigo E, Suberviola B, Santibáñez M, Belmar L, Castellanos Á, Heras M, et al. Association between recurrence of acute kidney injury and mortality in intensive care unit patients with severe sepsis. J Intensive Care. 2017;5:28. DOI: https://doi.org/10.1186/s40560-017-0225-0
Martensson J, Bellomo R. Sepsis-induced acute kidney injury. Crit Care Clin. 2015;31(4):649-60. DOI: https://doi.org/10.1016/j.ccc.2015.06.003
Poukkanen M, Vaara ST, Pettila V, Kaukonen KM, Korhonen AM, Hovilehto S, et al; FINNAKI study group. Acute kidney injury in patients with severe sepsis in Finnish intensive care units. Acta Anaesthesiol Scand. 2013;57(7):863-72. DOI: https://doi.org/10.1111/aas.12133
Patel S, Puri N, Dellinger RP. Sepsis Management for the Nephrologist. Clin J Am Soc Nephrol. 2022;17(6):880-9. DOI: https://doi.org/10.2215/CJN.14381121
Jiang YJ, Xi XM, Jia HM, Zheng X, Wang MP, Li WX. The attributable mortality of new-onset acute kidney injury among critically ill patients: a propensity-matched analysis based on a multicentre prospective cohort study. Int Urol Nephrol. 2022;54(8):1987-94. DOI: https://doi.org/10.1007/s11255-021-03087-z
Bozkurt FT, Doganci M, Kayar Calili D, Akdag A, Izdes S. Clinical characteristics and short-term outcome of dialysis-requiring acute kidney injury in critically ill patients. J Surg Med. 2020;4(7):558-61. DOI: https://doi.org/10.28982/josam.749996
Kellum JA, Chawla LS, Keener C, Singbartl K, Palevsky PM, Pike FL, et al. ProCESS and ProGReSS-AKI Investigators. The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock. Am J Respir Crit Care Med. 2016;193(3):281-7. DOI: https://doi.org/10.1164/rccm.201505-0995OC
Manrique-Caballero CL, Del Rio-Pertuz G, Gomez H. Sepsis-Associated Acute Kidney Injury. Crit Care Clin. 2021;37(2):279-301. DOI: https://doi.org/10.1016/j.ccc.2020.11.010
Jia HM, Jiang YJ, Zheng X, Li W, Wang MP, Xi XM, et al. The attributable mortality of sepsis for acute kidney injury: a propensity-matched analysis based on multicenter prospective cohort study. Ren Fail. 2023;45(1):2162415. DOI: https://doi.org/10.1080/0886022X.2022.2162415
Pereira M, Rodrigues N, Godinho I, Gameiro J, Neves M, Gouveia J, et al. Acute kidney injury in patients with severe sepsis or septic shock: a comparison between the ‘Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease’ (RIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. Clin Kidney J. 2017;10(3):332-40. DOI: https://doi.org/10.1093/ckj/sfw107
Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One. 2013;8(3):e59321. DOI: https://doi.org/10.1371/journal.pone.0059321
Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018;7(10):333. DOI: https://doi.org/10.3390/jcm7100333
Wang J, Zhao K, Mao X, Zhang Y, Shao J, Fan W, et al. Relationship between CRP Albumin Ratio and the Mortality in Critically Ill Patients with AKI: A Retrospective Observational Study. Biomed Res Int. 2021;2021:9957563. DOI: https://doi.org/10.1155/2021/9957563
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