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Master Thesis

Impact des caractéristiques de l’Insuffisance Rénale Aiguë en réanimation sur le pronostic rénal à long terme : MAKI une étude prospective multicentrique

Abstract : Background: Acute kidney injury (AKI) accounts for half of intensive care unit (ICU) patients. AKI can cause progression of chronic kidney disease (CKD). Limited data are available for ICU patients regarding renal prognosis based on characteristics of AKI. Few studies have found contrasting results regarding renal prognosis based on AKI duration. Moreover, no data exist regarding long-term renal prognosis after AKI in ICU based on the main pathophysiological mechanism. The MAKI study was designed to describe long-term renal prognosis after AKI in ICU according to AKI duration and pathophysiological mechanisms. Methods: The MAKI study is a multicentre prospective observational study. Renal prognosis will be evaluated for a cohort of 860 patients—all of whom have been hospitalized in ICU for more than 24 hours—through a composite assessment of major adverse kidney events (MAKE). A follow-up MAKE assessment will be conducted at 3 months and 12 months after AKI onset (or after ICU admission if no AKI occurred during the ICU stay). The patients will be classified into 3 groups based on the occurrence of AKI and its duration: 1) patients without AKI during their stay, 2) patients who had a transient AKI episode (defined as recovery within 48 hours of onset), and 3) patients who had a persistent AKI episode during their stay. MAKE outcomes include mortality and a worsening of CKD (defined as eGFR < 60ml/min/1.73m² or progression to a higher stage if CKD was present before AKI). Secondary analyses will assess patient MAKE outcomes according to the main pathophysiological mechanism of AKI: pre-renal, obstructive, or organic. Discussion: Current guidelines recommend a long-term follow-up assessment of kidney function after AKI in ICU, regardless of the pathophysiological mechanisms or duration of AKI. We hypothesize that transient or pre-renal AKI could be associated with a group of patients who have a better renal prognosis than their peers because the renal injury is weak. This result would indicate that this group could forgo a renal follow-up or have a different renal follow-up protocol. Deepening our knowledge of renal prognosis according to the type of AKI will enable clinicians to propose a personalized follow-up plan.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03534405
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Submitted on : Wednesday, January 19, 2022 - 2:17:50 PM
Last modification on : Friday, January 21, 2022 - 4:13:31 AM
Long-term archiving on: : Wednesday, April 20, 2022 - 6:43:48 PM

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Cécile Gosset. Impact des caractéristiques de l’Insuffisance Rénale Aiguë en réanimation sur le pronostic rénal à long terme : MAKI une étude prospective multicentrique. Human health and pathology. 2021. ⟨dumas-03534405⟩

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