Acute kidney injury in mechanically ventilated patients: The risk factor profile depends on the timing of aki onset

Raúl Lombardi, Nicolás Nin, Oscar Penũelas, Alejandro Ferreiro, Fernando Rios, Maria Carmen Marin, Konstantinos Raymondos, Jose A. Lorente, Younsuck Koh, Javier Hurtado, Marco Gonzalez, Fekri Abroug, Manuel Jibaja, Yaseen Arabi, Rui Moreno, Dimitros Matamis, Antonio Anzueto, Andres Esteban

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: Acute kidney injury (AKI) is a frequent complication in patients under mechanical ventilation (MV).We aimed to assess the risk factors for AKI with particular emphasis on those potentially preventable. Study Design, Setting, and Participants: Retrospective analysis of a large, multinational database of MV patients with >24 h of MV and normal renal function at admission. AKI was defined according to creatinine-based KDIGO criteria. Risk factors were analyzed according to the time point at which AKI occurred: early (48 h after ICU admission, AKIE) and late (day 3 to day 7 of ICU stay, AKIL). A conditional logistic regression model was used to identify variables independently associated with AKI. Results: Three thousand two hundred six patients were included. Seven hundred patients had AKI (22%), the majority of them AKIE (547/704). The risk factor profile was highly dependent upon the timing of AKI onset. In AKIE risk factors were older age; SAPS II score; postoperative and cardiac arrest as the reasons for MV; worse cardiovascular SOFA, pH, serum creatinine, and platelet count; higher level of peak pressure and Vt/kg; and fluid overload at admission. In contrast, AKIL was linked mostly to events that occurred after admission (lower platelet count and pH; ICU-acquired sepsis; and fluid overload). None ventilation-associated parameters were identify as risk factors for AKIL. Conclusions: In the first 48 h, risk factors are associated with the primary disease and the patient's condition at admission. Subsequently, emergent events like sepsis and organ dysfunction appear to be predictive factors making prevention a challenge.

Original languageEnglish (US)
Pages (from-to)411-417
Number of pages7
JournalShock
Volume48
Issue number4
DOIs
StatePublished - Oct 1 2017

Keywords

  • Acute kidney injury
  • Acute renal failure
  • Intensive care
  • Mechanical ventilation
  • Multiorgan dysfunction
  • Risk factors
  • Sepsis

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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    Lombardi, R., Nin, N., Penũelas, O., Ferreiro, A., Rios, F., Marin, M. C., Raymondos, K., Lorente, J. A., Koh, Y., Hurtado, J., Gonzalez, M., Abroug, F., Jibaja, M., Arabi, Y., Moreno, R., Matamis, D., Anzueto, A., & Esteban, A. (2017). Acute kidney injury in mechanically ventilated patients: The risk factor profile depends on the timing of aki onset. Shock, 48(4), 411-417. https://doi.org/10.1097/SHK.0000000000000871