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Predicting mortality among critically ill patients with acute kidney injury treated with renal replacement therapy: development and validation of new prediction models

Li D, Wald R, Blum D, McArthur E, James MT, Burns K, Friedrich JO, Adhikari NKJ, Nash DM, Lebovic G, Harvey AK, Dixon SN, Silver SA, Bagshaw SM, Beaubien-Souligny W. J Crit Care. 2020; 56:113-9. Epub 2019 Dec 18. DOI: https://doi.org/10.1016/j.jcrc.2019.12.015


Purpose — Severe acute kidney injury (AKI) is associated with a significant risk of mortality and persistent renal replacement therapy (RRT) dependence. The objective of this study was to develop prediction models for mortality at 90-day and 1-year following RRT initiation in critically ill patients with AKI.

Methods — All patients who commenced RRT in the intensive care unit for AKI at a tertiary care hospital between 2007 and 2014 constituted the development cohort. We evaluated the external validity of our mortality models using data from the multicentre OPTIMAL-AKI study.

Results — The development cohort consisted of 594 patients, of whom 320(54%) died and 40 (15% of surviving patients) remained RRT-dependent at 90-day Eleven variables were included in the model to predict 90-day mortality (AUC:0.79, 95%CI:0.76–0.82). The performance of the 90-day mortality model declined upon validation in the OPTIMAL-AKI cohort (AUC:0.61, 95%CI:0.54–0.69) and showed modest calibration. Similar results were obtained for mortality model at 1-year.

Conclusions — Routinely collected variables at the time of RRT initiation have limited ability to predict mortality in critically ill patients with AKI who commence RRT.

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