Background: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI).\nNo clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function\nrecovery of critically ill patients with D-AKI.\nMethods: We conducted a retrospective study investigating patients (ââ?°Â¥16 years old) admitted to an intensive care\nunit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly\nused dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated\nglomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge.\nResults: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between\nthe three study periods, (1999ââ?¬â??2003, 2004ââ?¬â??2008, and 2009ââ?¬â??2012) showed an increased in incidence of D-AKI\n(from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal\nreplacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate\n(53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who\nrecovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than\nthose in the intermittent hemodialysis group (54.0 Ã?â?? 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate\nanalysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional\nunit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with\nsepsis-associated AKI was estimated to be 2.93 (1.81ââ?¬â??4.75; p < 0.001).\nConclusion: Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also\nincreased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better\nbaseline kidney function, especially in the dialysis dependence patients at hospital discharge.
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