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The following is a summary of “Acute kidney injury after out-of-hospital cardiac arrest,” published in the May 2024 issue of Critical Care by Jeppesen et al.
Researchers conducted a retrospective study to investigate whether the severity of acute kidney injury (AKI) directly affects long-term survival after out-of-hospital cardiac arrest (OHCA) or simply reflects the seriousness of the initial condition.
They involved 789 comatose adult patients in OHCA with presumed cardiac cause and sustained ROSC, with 759 patients without prior dialysis-dependent kidney disease and surviving at least 48 h. The AKI was defined by the KDIGO classification, and patients were categorized into three groups—No AKI, AKI no CKRT, and AKI CKRT based on AKI development and CKRT need. The primary outcome was OS within 365 days post-OHCA, according to the AKI group. Adjusted Cox proportional hazard models were utilized to evaluate OS within 365 days across the three groups.
The results showed that in the entire population, the median age was 64 (54–73) years, 80% male, and 90% of patients presented with a shockable rhythm; the median time to ROSC was 18 (12–26) min. A total of 254 (33.5%) patients developed AKI according to the KDIGO definition, with 77 requiring CKRT and 177 not needing continuous renal replacement therapy (CKRT). The patients with AKI CKRT had a longer time-to-ROSC and worse metabolic derangement at hospital admission, and OS within 365 days from OHCA declined with the severity of kidney injury. Adjusted Cox regression analysis revealed that AKI, both with and without CKRT, was significantly linked to reduced OS up to 365 days, with comparable HRs relative to no AKI (HR 1.75, 95% CI 1.13–2.70 vs. HR 1.76, 95% CI 1.30–2.39).
Investigators concluded that developing AKI after OHCA, regardless of receiving CKRT, significantly reduced one-year survival rates in patients with resuscitated comatose compared to those without AKI.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04936-w
