Acute critical illness increases risk of kidney complications and death

Acute critical illness in people without previous renal disease puts them at risk of kidney complications as well as death, according to a study in published in CMAJ (Canadian Medical Association Journal).

"[P]atients with acute critical illness without apparent underlying renal disease — a group traditionally considered to be at low risk of renal diseases — have clinically relevant long-term renal risks," write Dr. Shih-Ting Huang and Dr. Chia-Hung Kao, Taichung Veterans General Hospital and China Medical University, Taichung, Taiwan, with coauthors.

Most studies have looked at patients with pre-existing kidney disease, while this study looked at data on 33 613 Taiwanese patients with critical acute illness and no pre-existing kidney disease compared with 63 148 controls for medium-term renal outcome. More than half the patients (53%) were over age 65 and two-thirds (67%) had high blood pressure. Patients who had experienced acute kidney illness were at increased risk of renal complications, developing chronic kidney disease and end-stage renal disease, with septicemia and septic shock being the strongest risk factors. Of the critically ill patients in the study, 335 developed end-stage renal disease, with a rate of 21 per 10 000 person-years compared with 4.9 per 10 000 person-years in the control group.

Patients who developed chronic kidney disease and end-stage renal disease were at a higher risk of death.

The authors suggest clinicians monitor kidney function at 30-90 days in patients with acute critical illness without preexisting renal disease and then at least yearly afterwards.

"Renal complications and subsequent mortality in acute critically ill patients without pre-existing renal disease" is published September 10, 2018.

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@CMAJ

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