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Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis

Abdel-Kader, Khaled, MD, MS1,2; Girard, Timothy, D., MD, MSCI3; Brummel, Nathan, E., MD, MSCI4,5,6; Saunders, Christina, T., BS7; Blume, Jeffrey, D., PhD7; Clark, Amanda, J., MD8; Vincz, Andrew, J., AA1,2; Ely, E., Wesley, MD, MPH4,5,9; Jackson, James, C., PsyD4,5,10,11; Bell, Susan, P., MBBS, MSCI6,12; Archer, Kristin, R., PhD, DPT13,14; Ikizler, T., Alp, MD1,2; Pandharipande, Pratik, P., MD, MSCI15; Siew, Edward, D., MD, MSCI1,2,9

doi: 10.1097/CCM.0000000000003003
Online Clinical Investigations

Objectives: Acute kidney injury frequently complicates critical illness and is associated with high morbidity and mortality. Frailty is common in critical illness survivors, but little is known about the impact of acute kidney injury. We examined the association of acute kidney injury and frailty within a year of hospital discharge in survivors of critical illness.

Design: Secondary analysis of a prospective cohort study.

Setting: Medical/surgical ICU of a U.S. tertiary care medical center.

Patients: Three hundred seventeen participants with respiratory failure and/or shock.

Interventions: None.

Measurements and Main Results: Acute kidney injury was determined using Kidney Disease Improving Global Outcomes stages. Clinical frailty status was determined using the Clinical Frailty Scale at 3 and 12 months following discharge. Covariates included mean ICU Sequential Organ Failure Assessment score and Acute Physiology and Chronic Health Evaluation II score as well as baseline comorbidity (i.e., Charlson Comorbidity Index), kidney function, and Clinical Frailty Scale score. Of 317 patients, 243 (77%) had acute kidney injury and one in four patients with acute kidney injury was frail at baseline. In adjusted models, acute kidney injury stages 1, 2, and 3 were associated with higher frailty scores at 3 months (odds ratio, 1.92; 95% CI, 1.14–3.24; odds ratio, 2.40; 95% CI, 1.31–4.42; and odds ratio, 4.41; 95% CI, 2.20–8.82, respectively). At 12 months, a similar association of acute kidney injury stages 1, 2, and 3 and higher Clinical Frailty Scale score was noted (odds ratio, 1.87; 95% CI, 1.11–3.14; odds ratio, 1.81; 95% CI, 0.94–3.48; and odds ratio, 2.76; 95% CI, 1.34–5.66, respectively). In supplemental and sensitivity analyses, analogous patterns of association were observed.

Conclusions: Acute kidney injury in survivors of critical illness predicted worse frailty status 3 and 12 months postdischarge. These findings have important implications on clinical decision making among acute kidney injury survivors and underscore the need to understand the drivers of frailty to improve patient-centered outcomes.

1Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN.

2Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Vanderbilt University Medical Center, Nashville, TN.

3Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

4Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.

5Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN.

6Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN.

7Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.

8Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.

9Geriatric Research, Education and Clinical Center (GRECC) Service at the Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.

10Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN.

11Divisions of Geriatric Medicine and General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.

12Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, TN.

13Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.

14Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.

15Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Supported, in part, by National Institutes of Health grants K23DK090304 (to Dr. Abdel-Kader), the Vanderbilt Center for Kidney Disease (to Drs. Abdel-Kader and Siew), the Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury Study 5U01 DK082192-08 (to Dr. Siew), and the Veterans Affairs Health Services Research and Development IIR 13–073 (to Dr. Siew).

Drs. Abdel-Kader, Girard, Brummel, Blume, Ely, Ikizler, and Pandharipande received support for article research from the National Institutes of Health (NIH). Dr. Girard’s institution received funding from the NIH. Dr. Ely’s institution received funding from the NIH and from Veterans Affairs funding, and he received funding from Orion, Abbott, and Pfizer. Dr. Bell’s institution received funding from the NIH-National Institute of Aging K23 career development award. Dr. Archer’s institution received funding from Patient-Centered Outcomes Research Institute and the Department of Defense and Pacira Pharmaceuticals, and received other support from the National Institute on Disability, Independent Living, and Rehabilitation Research, American Physical Therapy Association, and Brown University. Dr. Ikizler’s institution received funding from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Siew received other support from Vanderbilt Center for Kidney Disease, and he disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: khaled.abdel-kader@vanderbilt.edu

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