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Master Thesis

Description des trajectoires fonctionnelles rénales après une insuffisance rénale aiguë en réanimation : une cohorte prospective bordelaise de 5 ans

Abstract : Background Patients suffering from acute kidney injury (AKI) in intensive care unit (ICU) could have various clinical trajectories and outcomes (early, late, or absence of recovery; early or late relapse; acute kidney disease (AKD); or chronic kidney disease (CKD)) after discharge. The objective was to assess the kidney disease progression after the ICU discharge and evaluate the risk and timing of AKD and CKD to improve the efficiency of post-ICU clinics. Methods: we conducted a prospective five-year follow-up study in a medical ICU in Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion, or both, and developed an AKI (defined by KDIGO criteria) between September 2013 and May 2015 were included. We excluded the patients with a previous estimated glomerular filtration rate (eGFR) of <90mL/min/1.73m2. AKD was defined as a condition wherein the criteria for AKI stage 1 or greater persists ≥7 days after exposure. CKD was defined by an eGFR of <60ml/min/1.73m2 at least 90 days after the AKI. Renal recovery was defined by serum creatinine ≤125% of serum basal creatinine. Results: two hundred thirty-two patients were enrolled. SAPS II was 62 ± 19, and the reason for admission was sepsis for 118/232 (51%). Renal replacement therapy (RRT) was needed for 73/232 (31%) patients. Among the included patients, 109/232 (47%) developed AKD and 63/232 (27%) developed CKD. CKD followed AKD for 47/63 (75%) patients, and 16/63 (25%) patients developed de-novo CKD after renal recovery during the five-year follow-up. AKD (OR = 218.6 [21.82–7010]); age (OR = 1.06 [1.00–1.14]); diabetes (OR = 11.5 [2.2–85.7]), and late recovery (OR = 0.002 [3,6.10-5–0.04]) were independently associated with CKD at three years. Cumulative incidence of CKD was 44% CI95% [34–55] at a one-year follow-up, 50% CI95% [41–60] at a three-year follow-up, and 58 CI95% [50–66] at a five-year follow up. A post-intensive care clinic 90 days after the ICU discharge could have failed to detect CKD in 16/63 (25%) patients. Conclusion: there are different clinical trajectories after an AKI, and the path between AKI, AKD, and CKD is not linear. A post-intensive care clinic within three months of ICU discharge fails to detect CKD in a quarter of patients. These results support the need of a systemically follow-up after an episode of AKI.
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Submitted on : Wednesday, November 18, 2020 - 12:24:22 PM
Last modification on : Saturday, December 19, 2020 - 3:12:50 AM
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  • HAL Id : dumas-03011904, version 1



Arthur Orieux. Description des trajectoires fonctionnelles rénales après une insuffisance rénale aiguë en réanimation : une cohorte prospective bordelaise de 5 ans. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03011904⟩



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