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      Recovery after Acute Kidney Injury

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          Abstract

          Rationale: Little is known about how acute kidney injury (AKI) resolves, and whether patterns of reversal of renal dysfunction differ among patients with respect to ultimate recovery.

          Objectives: We sought to examine different patterns for AKI reversal that are found in patients and assess how they relate to postdischarge outcomes.

          Methods: We studied 16,968 critically ill patients with Kidney Disease Improving Global Outcomes stage 2 or 3 AKI, using an electronic database. Reversal of AKI was defined as alive and no longer meeting criteria for even stage 1. Recovery was defined as reversal at hospital discharge.

          Measurements and Main Results: We observed five patterns. The most common (4,508; 26.6%) was early reversal that was sustained through discharge, but almost as many patients (4,496; 26.5%) had no reversal at all. The remaining patients had late reversal after Day 7 (9.7%); early reversal with one or more relapses, but with ultimate recovery (22.5%); and relapsing without recovery (14.7%). Outcomes for patients with these phenotypes were quite different, with age-adjusted 1-year survival varying from more than 90% for early reversal to less than 40% for patients never reversing. Relapses are common (37.3%), especially in the first 72 hours after reversal, and are associated with a fivefold increased risk for death by 1 year compared with early sustained reversal.

          Conclusions: We have identified five distinct recovery phenotypes on the basis of the clinical course over the first week after AKI manifestation. These phenotypes may identify patients amenable to therapeutic intervention. Long-term outcomes are associated with recovery status at hospital discharge.

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          Author and article information

          Journal
          Am J Respir Crit Care Med
          Am. J. Respir. Crit. Care Med
          ajrccm
          American Journal of Respiratory and Critical Care Medicine
          American Thoracic Society
          1073-449X
          1535-4970
          15 March 2017
          15 March 2017
          15 March 2017
          : 195
          : 6
          : 784-791
          Affiliations
          [ 1 ]The Center for Critical Care Nephology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
          [ 2 ]University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
          [ 3 ]Department of Anesthesiology, University of Florida, Gainesville, Florida
          [ 4 ]Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; and
          [ 5 ]Department of Medicine, Veterans Affairs Medical Center, Washington, DC
          Author notes
          Correspondence and requests for reprints should be addressed to John A. Kellum, M.D., M.C.C.M., Center for Critical Care Nephrology, 604 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261. E-mail: kellumja@ 123456upmc.edu
          Author information
          http://orcid.org/0000-0003-1995-2653
          Article
          PMC5363967 PMC5363967 5363967 201604-0799OC
          10.1164/rccm.201604-0799OC
          5363967
          27635668
          f738e3c7-c219-4795-8741-39f567d14042
          Copyright © 2017 by the American Thoracic Society
          History
          : 18 April 2016
          : 16 September 2016
          Page count
          Figures: 3, Tables: 5, Pages: 8
          Categories
          Original Articles
          Critical Care

          survival,critical care,outcomes,dialysis,renal failure
          survival, critical care, outcomes, dialysis, renal failure

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