Gallop, Laura

Hickey, Jack

Johnson, Richard

Secombe, Paul

2025-01-17

Sepsis-associated acute kidney injury (SA-AKI) is common among patients admitted to the intensive care unit (ICU) with sepsis.This study aimed to demonstrate an association between an episode of SA-AKI and progression to dialysis dependence, with a view to identifying a cohort who may be suitable for intensive nephrology follow-up.Design: Retrospective data-linkage cohort study.Alice Springs Hospital ICU, 10-bed regional facility, housed in a 200-bed regional hospital, located in Central Australia.All patients admitted with a diagnosis code associated with sepsis between 2015 and 2017.Primary outcome was a composite measure comprising death or initiation of maintenance dialysis within 5 years of the index case of sepsis leading to ICU admission.The unadjusted risk of the composite outcome was significantly higher in the SA-AKI group (odds ratio (OR) 3.22, 95% confidence interval (CI) 1.81-5.74, P < 0.01). This effect remains after adjustment for age, illness severity and co-morbidities (adjusted OR (aOR) 2.64, 95% CI 1.22-5.68, P = 0.01). Progression to maintenance dialysis was the primary driver of this effect (OR 7.56, 95% CI 2.23-25.65, P = 0.02), although it was modified by the effect of confounders (aOR 7.3, 95% CI 0.7-75.94, P = 0.10).These results demonstrate an association between an index episode involving SA-AKI and the composite outcome in a defined population. Identification of this group may allow intensive nephrology follow-up and secondary prevention with the goal of mitigating the risk of progression of disease with significant economic and personal benefits.

Medical Retrieval and Consultation Centre, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia.

Research Unit, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia.

Director Research, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia.

School of Medicine, Flinders University, Adelaide, South Australia, Australia.

School of Medicine, Charles Darwin University, Darwin, Northern Territory, Australia.

School of Medicine, Flinders University, Adelaide, South Australia, Australia.

Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Centre For Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Victoria, Australia.

Intern Med J . 2025 Jan 17. doi: 10.1111/imj.16633. Online ahead of print.

1445-5994

https://pubmed.ncbi.nlm.nih.gov/39821592/?otool=iaurydwlib

https://hdl.handle.net/10137/13929

Australian Aboriginal and Torres Strait islander people

acute kidney injury

critical care

intensive care unit

nephrology

renal dialysis

sepsis

Severe sepsis-associated acute kidney injury and outcomes: a longitudinal cohort study.

Journal Article

Publication