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Article Dans Une Revue Annals of Intensive Care Année : 2023

Long-term outcomes after severe acute kidney injury in critically ill patients: the SALTO study

1 Hôpital Avicenne [AP-HP]
2 CoRaKID - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
3 CHU Pointe-à-Pitre/Abymes [Guadeloupe]
4 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
5 Centre Hospitalier René Dubos [Pontoise]
6 Hôpital Pellegrin
7 Centre Hospitalier Sud Francilien
8 CHU Angers - Centre Hospitalier Universitaire d'Angers
9 CHU Rouen
10 CHU Henri Mondor [Créteil]
11 CARMAS - Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis)
12 CHU Gabriel Montpied [Clermont-Ferrand]
13 CHRO - Centre Hospitalier Régional d'Orléans
14 CHU Pitié-Salpêtrière [AP-HP]
15 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
16 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
17 Hôpital Lariboisière-Fernand-Widal [APHP]
18 Centre Hospitalier Victor Dupouy
19 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
20 Hôpital Nord [CHU - APHM]
21 CHU Amiens-Picardie
22 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
23 Hôpital de la Croix-Rousse [CHU - HCL]
24 CH Cholet - Centre Hospitalier de Cholet
25 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
26 CHIC - Centre Hospitalier Intercommunal de Créteil
27 Registre REIN
28 Hôpital Louis Mourier - AP-HP [Colombes]
29 UPCité - Université Paris Cité
Dorothée Carpentier
  • Fonction : Auteur
Cécile Couchoud
  • Fonction : Auteur

Résumé

Abstract Background The extent of the consequences of an episode of severe acute kidney injury (AKI) on long-term outcome of critically ill patients remain debated. We conducted a prospective follow-up of patients included in a large multicenter clinical trial of renal replacement therapy (RRT) initiation strategy during severe AKI (the Artificial Kidney Initiation in Kidney Injury, AKIKI) to investigate long-term survival, renal outcome and health related quality of life (HRQOL). We also assessed the influence of RRT initiation strategy on these outcomes. Results Follow-up of patients extended from 60 days to a median of 3.35 years [interquartile range (IQR), 1.89 to 4.09] after the end of initial study. Of the 619 patients included in the AKIKI trial, 316 survived after 60 days. The overall survival rate at 3 years from inclusion was 39.4% (95% CI 35.4 to 43.4). A total of 46 patients (on the 175 with available data on long-term kidney function) experienced worsening of renal function (WRF) at the time of follow-up [overall incidence of 26%, cumulative incidence at 4 years: 20.6% (CI 95% 13.0 to 28.3)]. Fifteen patients required chronic dialysis (5% of patients who survived after day 90). Among the 226 long-term survivors, 80 (35%) answered the EQ-5D questionnaire. The median index value reported was 0.67 (IQR 0.40 to 1.00) indicating a noticeable alteration of quality of life. Initiation strategy for RRT had no effect on any long-term outcome. Conclusion Severe AKI in critically ill patients was associated with a high proportion of death within the first 2 months but less so during long-term follow-up. A quarter of long-term survivors experienced a WRF and suffered from a noticeable impairment of quality of life. Renal replacement therapy initiation strategy was not associated with mortality outcome. Graphical Abstract
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Dates et versions

hal-04032380 , version 1 (28-09-2023)

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Citer

Khalil Chaïbi, Franck Ehooman, Bertrand Pons, Laurent Martin-Lefevre, Eric Boulet, et al.. Long-term outcomes after severe acute kidney injury in critically ill patients: the SALTO study. Annals of Intensive Care, 2023, 13 (1), pp.18. ⟨10.1186/s13613-023-01108-x⟩. ⟨hal-04032380⟩
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