Hemodialysis.com

Hemodialysis.com eInterview with Dr. Susanne Stads
Department of Intensive Care
Erasmus Medical Center, H-626
PO Box 2040, 3000 CA Rotterdam, the Netherlands.

Hemodialysis.com: What are the main findings of the study?

Dr. Stads: Acute Kidney Injury requiring renal replacement therapy is associated with high in-hospital mortality. Little is known about renal recovery in surviving patients and the impact of impaired kidney function on long-term renal and overall survival.

In a retrospective cohort study, we evaluated the association between impaired kidney function at hospital discharge with long-term renal and overall survival. The median follow up in our cohort was 8.5 years (range 1-17 years). Only 35% (n=170) of patients in our cohort were discharged with an estimated GFR > 60 ml/min per 1.73m². An estimated GFR < 30 ml/min per 1.73m² was a strong and independent predictor for decreased long-term survival and poor renal survival.

Hemodialysis.com: Were any of the findings unexpected?

Dr. Stads:  Some studies have described an association between impaired kidney function after discharge and worse long-term overall survival. However, none of these studies had a follow up period as long as ours and a cohort as divers as ours.

Furthermore after multivariate analysis we found no association between cardiovascular risk factors, such as hypertension and diabetes mellitus and survival. After multivariate analysis only age and end-stage-renal disease were predictors of decreased survival.

Hemodialysis.com: What should clinicians and patients take away from this study?

Dr. Stads: The majority of patients is discharged with an impaired kidney function, after an episode of RRT-necessitating acute kidney injury. Impaired kidney function at discharge is independently associated with decreased long-term renal and overall survival. Therefore it is important that further deterioration of kidney function is prevented, and for example radio-contrast studies and nephrotoxic medication are avoided as much as possible. Nephrologic follow up is recommended for patients discharged with incomplete renal recovery to minimize the complications of chronic kidney disease.

Hemodialysis.com: What recommendations What recommendations do you have for future research as a result of your study?

Dr. Stads:  It would be interesting to analyse these findings in a prospective study, and to evaluate whether kidney function at hospital discharge and outcome can be influenced by close follow up of these patients.

Furthermore it would be interesting to analyze whether renal recovery will take place, and the group that does develop renal recovery, do they experience better survival?

Is there a survival benefit when these patients are seen at follow up by a nephrologist?

Citation:

Impaired Kidney Function at Hospital Discharge and Long-Term Renal and Overall Survival in Patients Who Received CRRT

Stads S, Fortrie G, van Bommel J, Zietse R, Betjes MG.

Department of Nephrology and Transplantation and, †Department of Intensive Care, ErasmusMedicalCenter, Rotterdam, The Netherlands.

Clin J Am Soc Nephrol. 2013 Apr 18. [Epub ahead of print]

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