TY  - JOUR
A1  - Zhang, J
A1  - Crichton, S
A1  - Dixon, A
A1  - Seylanova, N
A1  - Peng, ZY
A1  - Ostermann, M
KW  - Science & Technology
KW  -  Life Sciences & Biomedicine
KW  -  Critical Care Medicine
KW  -  General & Internal Medicine
KW  -  Acute kidney injury
KW  -  Recovery
KW  -  Cumulative fluid balance
KW  -  BODY-MASS INDEX
KW  -  AKI
KW  -  MANAGEMENT
KW  -  OBESITY
KW  -  OUTCOMES
KW  -  FAILURE
KW  -  RISK
KW  -  UNIT
JF  - Critical Care
UR  - https://doi.org/10.1186/s13054-019-2673-5
PB  - BMC
N2  - Background: Acute kidney injury (AKI) is common in patients in the intensive care unit (ICU) and may be present
on admission or develop during ICU stay. Our objectives were (a) to identify factors independently associated with
the development of new AKI during early stay in the ICU and (b) to determine the risk factors for non-recovery of
AKI.
Methods: We retrospectively analysed prospectively collected data of patients admitted to a multi-disciplinary ICU
in a single tertiary care centre in the UK between January 2014 and December 2016. We identified all patients
without AKI or end-stage renal failure on admission to the ICU and compared the outcome and characteristics of
patients who developed AKI according to KDIGO criteria after 24 h in the ICU with those who did not develop AKI
in the first 7 days in the ICU. Multivariable logistic regression was applied to identify factors associated with the
development of new AKI during the 24?72-h period after admission. Among the patients with new AKI, we
identified those with full, partial or no renal recovery and assessed factors associated with non-recovery.
Results: Among 2525 patients without AKI on admission, the incidence of early ICU-acquired AKI was 33.2% (AKI I
41.2%, AKI II 35%, AKI III 23.4%). Body mass index, Sequential Organ Failure Assessment score on admission, chronic
kidney disease (CKD) and cumulative fluid balance (FB) were independently associated with the new development
of AKI. By day 7, 69% had fully recovered renal function, 8% had partial recovery and 23% had no renal recovery.
Hospital mortality was significantly higher in those without renal recovery. Mechanical ventilation, diuretic use, AKI
stage III, CKD, net FB on first day of AKI and cumulative FB 48 h later were independently associated with nonrecovery
with cumulative fluid balance having a U-shape association.
Conclusions: Early development of AKI in the ICU is common and mortality is highest in patients who do not
recover renal function. Extreme negative and positive FB were strong risk factors for AKI non-recovery.
ID  - discovery10091620
IS  - 1
N1  - This work is licensed under a Creative Commons Attribution 4.0 International License. The images
or other third party material in this article are included in the Creative Commons license,
unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license,
users will need to obtain permission from the license holder to reproduce the material. To view a copy of this
license, visit http://creativecommons.org/licenses/by/4.0/
Y1  - 2019/12/03/
AV  - public
VL  - 23
EP  - 10
TI  - Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis
ER  -