Epidemiology and long-term outcomes of critically ill patients with severe AKI in India and Southeast Asia.
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Tangchitthavorngul Suri, Lumlertgul Nuttha, Peerapornratana Sadudee, Mai Anh Tuan, Hasan Mohd Shahnaz, Loh Carolyn Tze Ing, Kumthekar Girish V, Chakravarthi Rajasekara, Jonny Jonny, Gafor Abdul Halim Abdul, Parapiboon Watanyu, Nimkietkajorn Veerapatr, Intarak Sompote, Sukmark Theerapon, Khositrangsikun Kamol, Oranrigsupak Petchdee, Aksornrat Atchara, Mazlan Mohd Zulfakar, Chuasuwan Anan, Tangvoraphonkchai Kamonwan, Pham Thao T N, Truong Tien D, Tran Linh T, Truong Viet Ha T, Dinh Ly T, Nguyen Bach X, Trieu Ngan Hoang Kim, Le Yen H, Nguyen Duy L M, Sengthavisouk Noot, Surasit Karjbundid, Tantiyavarong Pichaya, Pongsittisak Wanjak, Tran Phu Nguyen Trong, Tungsanga Kriang, Avihingsanon Yingyos, Srisawat Nattachai
Аннотация
METHODS: We analyzed data from the India and Southeast Asia Renal Replacement Therapy (InSEA-RRT) registry, a multicenter cohort study conducted between April 2019 and December 2023 across 24 hospitals in Southeast Asia and India. Critically ill patients with AKI stage 3, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, were enrolled. The primary outcome was 2-year MAKE, defined as a composite of persistent kidney dysfunction, long-term dialysis, and all-cause mortality at 2 years post-enrollment.
RESULTS: A total of 2,315 patients were enrolled, of whom 1,033 (47%) died during hospitalization. Among surviving patients, the incidence of 2-year MAKE was 46.6 per 100 person-years (95% CI 42.7-50.6). Notably, mortality (32%) was the dominant component of MAKE. The incidence of new chronic kidney disease (CKD) and CKD progression at 2 years post-AKI was 58.6 and 35.4 per 100 person-year (95% CI 51.0-67.0 and 26.0-47.0), respectively. Multivariable-adjusted models identified older age, male sex, preexisting CKD, malignancy, cardiac-associated AKI, and non-recovery of kidney function after AKI as independent risk factors for 2-year MAKE.
CONCLUSIONS: Patients with severe AKI face a high incidence of 2-year MAKE and poor long-term clinical outcomes. Early recognition and close follow-up of these patients are crucial. Further research is needed to identify effective strategies to improve long-term outcomes in this high-risk population.