Prognostic indicators of adverse renal outcome and death in acute kidney injury hospital survivors

Introduction: Data regarding prognostic factors of post-discharge mortality and adverse renal function outcome in acute kidney injury (AKI) hospital survivors are scarce and controversial. Objectives: We aimed to identify predictors of post-discharge mortality and adverse renal function outcome in AKI hospital survivors. Patients and Methods: The study group consisted of 84 AKI hospital survivors admitted to the tertiary medical center during 2-year period. Baseline clinical parameters, with renal outcome 3 months after discharge and 6-month mortality were evaluated. According survival and renal function outcome, patients were divided into two groups. Results: Patients who did not recover renal function were statistically significantly older (P < 0.007) with higher Charlson comorbidity index (CCI) score (P < 0.000) and more likely to have anuria and oliguria (P = 0.008) compared to those with recovery. Deceased AKI patients were statistically significantly older (P < 0.000), with higher CCI score (P < 0.000), greater prevalence of sepsis (P = 0.004), higher levels of C-reactive protein (CRP) (P < 0.017) and ferritin (P < 0.051) and lower concentrations of albumin (P < 0.01) compared to survivors. By multivariate analysis, independent predictors of adverse renal outcome were female gender (P = 0.033), increasing CCI (P = 0.000), presence of pre-existing chronic kidney disease (P = 0.000) and diabetes mellitus (P = 0.019) as well as acute decompensated heart failure (ADHF) (P = 0.032), while protective factor for renal function outcome was higher urine output (P = 0.009). Independent predictors of post-discharge mortality were female gender (P = 0.04), higher CCI score (P = 0.001) and sepsis (P = 0.034). Conclusion: Female AKI hospital survivors with increasing burden of comorbidities, diagnosis of sepsis and ADHF seem to be at high-risk for poor post-discharge outcome.