Kirby Mayer, PT, DPT
Assistant Professor
University of Kentucky
Lexington, Kentucky, United States
Disclosure information not submitted.
Victor Ortiz Soriano
Research Coordinator
University of Kentucky, United States
Disclosure information not submitted.
Alborz Kalantar
Medical Student
University of Louisville, United States
Disclosure information not submitted.
Joshua Lambert, PhD
Assistant Professor
University of Cincinnati, United States
Disclosure information not submitted.
Peter Morris, MD
Professor
University of Alabama at Birmingham, United States
Disclosure information not submitted.
Javier Neyra, MD, MSCS
Associate Professor
University of Kentucky College of Medicine, United States
Disclosure information not submitted.
Title: Acute kidney injury leads to worse physical outcomes in survivors of critical illness
Introduction: Patients surviving critical illness are at risk of long-term physical, emotional and cognitive impairments, collectively referred to as Post-Intensive Care Syndrome (PICS). Modifiable and non-modifiable risk factors may increase likelihood of PICS. We hypothesize that the occurrence of AKI in the ICU leads to worse short-term physical debility. The purpose of this study was to compare physical, emotional and cognitive health in survivors of critical illness with and without AKI.
Methods: Retrospective observational study of adult survivors of critical illness due to sepsis and/or acute respiratory failure who attended follow-up in a specialized ICU Recovery Clinic. Outcomes were evaluated during 3-month visit and comprised validated tests for evaluation of physical function, muscle strength, cognitive and emotional health, and self-reported health-related quality of life (HRQOL).
Results: A total of 104 patients with median age of 55 [49-64] years, 54% male, and median SOFA score of 10 [8-12] were analyzed. Incidence of AKI during ICU admission was 61% and 19.2% of patients required renal replacement therapy (RRT). Patients with AKI stage 2 or 3 (vs. those with AKI stage 1 or no AKI) walked less on the 6-minute walk test (223 ± 132 vs. 295 ± 153 meters, p=0.059) and achieved lower of the predicted walk distance (38% vs. 58%, p=0.041). Similar patterns of worse physical function and more significant muscle weakness were observed in multiple tests, with overall worse metrics in patients that required RRT. Patients with AKI stage 2 or 3 also reported lower HRQOL scores when compared to their counterparts, including less ability to return to work or hobby, or reengage in driving. There were no significant differences in cognitive function or emotional health between groups.
Conclusions: Survivors of critical illness and AKI stage 2 or 3 have increased physical debility and overall lower quality of life, with more impairment in return to work/hobby and driving when compared to their counterparts without AKI or AKI stage 1 at 3 months post-discharge.