Acute Critical Illness Increases the Risk of Kidney Complications

Highlights:

Patients with acute critical illness without underlying kidney disease, generally considered a low-risk group for kidney disease, ended up with a high risk of clinically relevant long-term kidney problems
Examples of Acute critical illnesses included severe trauma, sepsis, myocardial infarction (MI) or post cardiac arrest syndrome (PCAS)
Monitoring kidney function regularly of patients with acute critical illness episode without preexisting renal disease is necessary. Follow up monitoring should happen between one month to three months and then yearly afterward

Patients who were admitted in hospitals with acute critical illness but without previous renal or kidney disease had a higher risk of kidney complications as well as death, according to a study in published in CMAJ (Canadian Medical Association Journal).

Acute critical illnesses include severe trauma, sepsis, myocardial infarction (MI) or post cardiac arrest syndrome (PCAS).

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Acute Renal Failure
Acute renal failure is the sudden cessation of the functioning of kidneys, that can be due to reduced renal blood flow, damage to renal tissues.

‘Acute critical illness in patients without any existing kidney disease puts them at an increased risk of kidney complications and even death.’

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"Patients with the acute critical illness without apparent underlying renal disease - a group traditionally considered to be at low risk of renal diseases - have clinically relevant long-term renal risks," write Dr. Shih-Ting Huang and Dr. Chia-Hung Kao, Taichung Veterans General Hospital and China Medical University, Taichung, Taiwan, with coauthors.

Most of the studies conducted earlier have looked at patients with pre-existing kidney disease.

The study entitled 'Renal Complications and Subsequent mortality in acute critically ill patients without pre-existing renal disease' is a significant new finding and all clinicians and patients should be aware of this risk both in short and long term.

Septicemia
Septicemia or sepsis is a serious illness wherein a patient develops symptoms due to presence of microbes or their toxins in the blood. Septicemia or sepsis is caused by bacteria, viruses and fungi.

This study looked at 33,613 Taiwanese adult patients with no pre-existing renal disease and admitted for acute critical illness between 2000 and 2011, from the Taiwan National Health Insurance Research Database.

Each patient was matched 1:2 with controls without acute critical illness - the total number of control patients was 63,148.

In all, 67 percent of the patients had high blood pressure, and around 53 percent of them were over age 65.

The team looked at data from both the groups for outcomes that included acute kidney injury, chronic kidney disease, and end-stage renal disease.

Patients with an acute kidney illness were at an increased risk of renal complications, with the highest incidence of developing chronic kidney disease. The incidence rates per 10 000 person-years were 78.3 for chronic kidney disease, 21.0 for end-stage renal disease, and 9.45 for acute kidney injury
The strongest risk factors for the above three renal complications were septicemia and septic shock
Patients with acute critical illness who subsequently developed chronic kidney disease and end-stage renal disease were at a higher risk of death

The authors suggest monitoring the kidney function of patients with acute critical illness without preexisting renal disease from 30 to 90 days and then yearly afterward.

References :

Shih-Ting Huang MD, Tai-Yuan Ke MD, Ya-Wen Chuang MD, Cheng-Li Lin MSc, Chia-Hung Kao MD., "Renal complications and subsequent mortality in acute critically ill patients without pre-existing renal disease" CMAJ (2018) September 10;190:E1070-80. doi: 10.1503/cmaj.171382
Acute kidney failure - (https://www.mayoclinic.org/diseases-conditions/kidney-failure/symptoms-causes/syc-20369048)

Source: Medindia

Cardiac Arrest
Cardiac arrest occurs when the heart stops beating abruptly due to an electrical malfunction. Blood flow to vital organs is cut off causing unconsciousness.