[Long-term outcome after dialysis-dependent renal failure on the intensive care unit]

Acute kidney injury (AKI) is a common and serious complication of acute life-threatening diseases.

The aim of this study was to investigate the effect of acute renal failure on mortality in intensive care patients, the need for renal replacement therapy at discharge, and the effect on long-term mortality.

Evaluation of 118 patient cases with dialysis-dependent acute renal failure between November 2016 and December 2017 admitted to a medical intensive care unit (ICU) at the University Hospital Tübingen, Germany. Dialysis at discharge and 1‑year mortality were defined as the primary endpoints. The secondary endpoint was need for continuous renal replacement after 18 months.

In 118 patients, renal replacement modality by means of hemodialysis became necessary. A mortality rate of 45.8% (54/118) was found in patients requiring dialysis. Of the 64 surviving dialysis-dependent patients, 35.9% were still dependent on renal replacement therapy at the time of discharge. The 1‑year mortality rate was significantly higher in patients that still required dialysis at the time of discharge (p = 0.004). At 18-month follow-up, seven patients (10.9%) were still on renal replacement therapy. At this time, dialysis was significantly more frequent in patients with dialysis at the time of discharge than in dialysis-free patients (7.1% vs. 71.4%, p = 0.001).

Severe episodes of AKI requiring renal replacement therapy in the setting of an ICU are associated with increased mortality 1 year after discharge and an increased requirement for renal replacement 18 months after discharge.