Impact of Early Renal Recovery on 90-Day Outcomes in Critically ill Patients with Sepsis-Induced Acute Kidney Injury: A Retrospective Cohort Investigation

Abstract

Objective: This study aims to investigate the impact of early renal recovery on 90-day outcomes in critically ill patients with sepsis-associated acute kidney injury (SA-AKI). The primary objective is to assess whether early renal recovery within the first seven days after AKI diagnosis is associated with improved survival and reduced progression to chronic kidney disease (CKD).

Methods: This retrospective cohort study was conducted at a tertiary care hospital between January 2015 and March 2017. Adult patients admitted to the intensive care unit (ICU) with sepsis and developing AKI within 48 hours of admission were included. AKI was diagnosed according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Patients were classified into three groups based on early recovery status: complete recovery, partial recovery, and unrecovered.

Results: A total of 556 patients with SA-AKI were included in the study. Early renal recovery was observed in 47.7% of patients, partial recovery in 14.0%, and no recovery in 38.3%. The unrecovered group exhibited significantly higher 90-day mortality (65.7%) and need for chronic dialysis (68.1%) compared to the complete recovery (22.6%) and partial recovery (28.2%) groups. Multivariate logistic regression identified male sex, congestive heart failure, pneumonia, anemia, mechanical ventilation, and AKI Stage 3 as independent risk factors for unrecovered renal function.

Conclusion: Early renal recovery within seven days of AKI diagnosis is associated with improved survival and reduced long-term renal dysfunction in patients with SA-AKI. The absence of early recovery significantly increases the risk of mortality and the need for chronic dialysis. Identifying patients at high risk for non-recovery could inform clinical strategies to improve outcomes in this population.