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Objective:
Sepsis induced acute kidney injury (S-AKI) is a syndrome of acute renal impairment complicating sepsis, occurring in over 40% of patients admitted to intensive care (ICU) with an established link to progression to chronic kidney disease (CKD). Central Australia has the highest rates of dialysis dependent CKD (CKD5D) in Australia. This study aims to demonstrate a link between an episode of S-AKI and the composite primary outcome of progression to death or CKD5D thereby identifying a cohort amenable to intervention reducing or delaying the primary outcome.
Design:
A retrospective cohort study
Setting:
Alice Springs Hospital (ASH) is a 200 bed regional hospital providing the only critical care facility for an area exceeding 1.5 million square kilometres with a 10 bed Intensive Care Unit (ICU) admitted approximately 600 patients per year.
Participants:
Patients admitted with a diagnosis code associated with sepsis to ASH ICU.
Main outcome measures:
Primary outcome was a composite of death or initiation of maintenance dialysis within 5 years of the index case of sepsis leading to ICU admission
Results:
The unadjusted risk of death or dialysis dependence is significantly higher in the S-AKI group (OR 3.19, 95% CI 1.83-5.57, p < 0.01). This effect remains after adjustment for age, illness severity, and co-morbidities (aOR 3.35, 95% CI 1.76 - 3.47, p < 0.01).
Conclusion(s):
These results demonstrate the link between S-AKI and composite outcome in a defined population in whom from intensive follow-up and secondary prevention may reduce or delay progression of disease with significant economic and personal benefits.
Discussion:
The importance of these findings lie in the recognition of a patient cohort within an already high-risk population; First Nations people in Central Australia have some of the highest rates of CKD and dialysis dependence in the world. international literature suggests that close nephrologist follow-up can reduce mortality in sever CKD. Resource limitations and geography mean that not all CKD patients in an area such as Central Australia can be provided with that level of care and many patients do not present until late in the pathway of CKD. The authors suggest that a novel model of care should be co-designed with primary care and ACCHO partners to closely manage ongoing risk factors in this cohort following an episode of sepsis, similar to that for rheumatic fever and rheumatic heart disease. |
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