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Ashine TM, Mekonnen MS, Heliso AZ, Wolde YD, Babore GO, Bushen ZD, Ereta EE, Saliya SA, Muluneh BB, Jemal SA. Incidence and predictors of acute kidney injury among adults admitted to the medical intensive care unit of a Comprehensive Specialized Hospital in Central Ethiopia. PLoS One 2024; 19:e0304006. [PMID: 38924008 PMCID: PMC11207181 DOI: 10.1371/journal.pone.0304006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/04/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Acute kidney injury is a prevalent complication in the Intensive Care Unit (ICU) and a significant global public health concern. It affects approximately 13 million individuals and contributes to nearly two million deaths worldwide. Acute kidney injury among Intensive Care Unit patients is closely associated with higher rates of morbidity and mortality. This study aims to assess the incidence of acute kidney injury and identify predictors among adult patients admitted to the medical Intensive Care Unit. METHOD A retrospective follow-up study was conducted by reviewing charts of 317 systematically selected patients admitted to the Intensive Care Unit from September 1, 2018, to August 30, 2022, in Wachemo University Nigist Ellen Mohammed Memorial Comprehensive Specialized Hospital. The extraction tool was used for the data collection, Epi-data version 4.6.0 for data entry, and STATA version 14 for data cleaning and analysis. The Kaplan-Meier, log-rank test, and life table were used to describe the data. The Cox proportional hazard regression model was used for analysis. RESULTS Among the total study participants, 128 (40.4%) developed Acute Kidney Injury (AKI). The incidence rate of Acute Kidney Injury was 30.1 (95% CI: 25.33, 35.8) per 1000 person-days of observation, with a median survival time of 23 days. It was found that patients with invasive mechanical ventilation (AHR = 2.64; 95% CI: 1.46-4.78), negative fluid balance (AHR = 2.00; 95% CI: 1.30-3.03), hypertension (AHR = 1.6; 95% CI: 1.05-2.38), and a vasopressor (AHR = 1.72; 95% CI: 1.10-2.63) were independent predictors of acute kidney injury. CONCLUSION The incidence of Acute Kidney Injury was a major concern in the ICU of the study area. In the intensive care unit (ICU), it was found that patients with vasopressors, invasive mechanical ventilation, negative fluid balance, and chronic hypertension were independent predictors of developing AKI. It would be better if clinicians in the ICU provided targeted interventions through close monitoring and evaluation of those patients with invasive ventilation, chronic hypertension, negative fluid balance, and vasopressors.
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Affiliation(s)
- Taye Mezgebu Ashine
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Migbar Sibhat Mekonnen
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Asnakech Zekiwos Heliso
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Yesuneh Dejene Wolde
- Department of Midwifery, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Getachew Ossabo Babore
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Zerihun Demisse Bushen
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Elias Ezo Ereta
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Sentayehu Admasu Saliya
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Bethelhem Birhanu Muluneh
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Samrawit Ali Jemal
- Department of Midwifery, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
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Bosomprah S, Bjonstad EC, Musuku J, Siyumbwa N, Ngandu M, Chisunka M, Banda P, Goma F, Mweemba A. Burden of chronic kidney diseases and underlying causes in Zambia: evidence from the global burden of disease study 2019. BMC Nephrol 2023; 24:39. [PMID: 36800948 PMCID: PMC9938689 DOI: 10.1186/s12882-023-03078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/01/2023] [Indexed: 02/20/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) has been a global public health problem and a major source of suffering and poor quality of life for those afflicted. Using data from the global burden of disease (GBD) study 2019, we estimated the magnitude of the burden of CKD as well as the underlying causes of CKD in the Zambian population. METHOD The data used for this study were extracted from the GBD 2019 study. The GBD 2019 provides estimates of several metrics of disease burden including the commonly used disability-adjusted life year (DALYs) for over 369 diseases and injuries, and 87 risk factors and combinations of these in 204 countries and territories from 1990 to 2019. We estimated the burden of CKD as the number and rates (per 100,000 population) of DALYs, disaggregated by year, sex, and age group. We examined the underlying causes of CKD by estimating the population attributable fraction as the percentage contributions of risk factors to CKD DALY. RESULTS The number of DALYs for CKD was estimated as 76.03 million (95% UI: 61.01 to 93.36) in 2019 compared to 39.42 million (95% UI: 33.09 to 45.90) in 1990, representing 93% increase whereas the DALYs rate per 100,000 population was estimated as 416.89 (95% UI: 334.53 to 511.93) in 2019 compared to 496.38 (95% UI: 416.55 to 577.87) in 1990, representing 16% reduction. CKD due to hypertension accounted for 18.7% of CKD DALYs and CKD due to diabetes (types 1 and 2) accounted for 22.7%, while CKD from glomerulonephritis accounted for the most DALYs at 33%. The age group most impacted from CKD were adolescents and young adults. CONCLUSION The burden of CKD remains high in the Zambian population with diabetes, high blood pressure, and glomerulonephritis as important causes. The results highlight the need to develop a comprehensive action plan to prevent and treat kidney disease. Increasing the awareness of CKD among the public as well as adaptation of guidelines for treating patients with end stage kidney disease are important considerations.
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Affiliation(s)
- Samuel Bosomprah
- Research Department, Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia. .,Department of Biostatistics, School of Public Health, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana. .,Noncommunicable Diseases and Injury Commission, Lusaka, Zambia.
| | - Erica C. Bjonstad
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - John Musuku
- Noncommunicable Diseases and Injury Commission, Lusaka, Zambia ,grid.415794.a0000 0004 0648 4296Ministry of Health, Lusaka, Zambia
| | - Namasiku Siyumbwa
- Noncommunicable Diseases and Injury Commission, Lusaka, Zambia ,grid.415794.a0000 0004 0648 4296Ministry of Health, Lusaka, Zambia
| | - Mwila Ngandu
- grid.418015.90000 0004 0463 1467Research Department, Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Mukobe Chisunka
- grid.418015.90000 0004 0463 1467Research Department, Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia ,Noncommunicable Diseases and Injury Commission, Lusaka, Zambia
| | - Patrick Banda
- Noncommunicable Diseases and Injury Commission, Lusaka, Zambia ,grid.415794.a0000 0004 0648 4296Ministry of Health, Lusaka, Zambia
| | - Fastone Goma
- Noncommunicable Diseases and Injury Commission, Lusaka, Zambia ,grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - Aggrey Mweemba
- Noncommunicable Diseases and Injury Commission, Lusaka, Zambia ,grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia ,grid.79746.3b0000 0004 0588 4220Department of Internal Medicine, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
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Kasongo N, Siziya S, Banda J. Clinical profile and predictors of renal failure in emergency department patients at a tertiary level hospital, a cross sectional study. Afr J Emerg Med 2022; 12:456-460. [PMID: 36397992 PMCID: PMC9664393 DOI: 10.1016/j.afjem.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Our study was able to highlight the profile of patients at risk of renal failure who were likely older, hypertensive, oliguric and with low hemoglobin compared to those without. This Knowledge can help care givers and policy makers to pay particular attention and institute interventions targeted at treating non communicable diseases (that lead to renal failure) and infections there by reducing progressing to renal failure and end stage renal disease with need for renal replacement therapy. In addition, it also showed that simple bedside tests like dip stick urinalysis and urine output monitoring are key in surveillance of renal failure.
Background Since establishment of the emergency departments (ED) in the country, there is lack of information on clinical profile of patients admitted to the ED and predictors of renal failure in these patients. Renal failure is prevalent in critical patients and a cause of significant mortality and morbidity. The aim of this study was to assess the clinical profile and predictors of renal failure in admissions to the ED. Methods This was a cross-sectional study that was conducted at a tertiary level hospital in Zambia from January to December, 2019 among admissions to the ED after ethical approval. The primary outcome of the study was to describe the clinical profile of admissions to the ED and proportion of renal failure defined as estimated glomerular filtration rate (eGFR) < 60 mls/1.72 m2 Results The final analysis includes 152 patients, 7 excluded for missing key data. The median age was 43.5 years (IQR 32.5-59.5) and 94.7% of patients were medical. Nearly 70.0% of the patients were triaged as emergency (red) or very urgent (orange). The reason for admission to the ED were sepsis and/or sepsis shock in 25.0%, diabetic hyperglycaemia emergencies in 20.0%, hypertensive crisis in 10.5%, respiratory failure (9.9%), severe malaria (7.9%) and poisoning (5.0%). The prevalence of renal failure was 36.1% and proteinuria was observed in 23.0%. Oliguria and hypertension were 5.9-fold and 1.7-fold independent predictors of renal failure in the ED. Patients with renal failure were likely older, hypertensive, oliguric and anaemic compared to those without. During admission to the ED, 19.1% died. Conclusion Sepsis and diabetic and hypertensive emergencies accounted for nearly half of ED admissions. Hypertension and oliguria were key predictors of renal failure. Early diagnosis, management and follow-up of hypertension including urine output monitoring for high-risk patients is key in surveillance and prevention of renal failure.
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Affiliation(s)
- Nancy Kasongo
- Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
- Copperbelt University School of Medicine, Ndola, Zambia
- Corresponding author.
| | - Seta Siziya
- Copperbelt University School of Medicine, Ndola, Zambia
| | - Justor Banda
- Department of Internal Medicine, Ndola Teaching Hospital, Ndola, Zambia
- Department of Medical Sciences, University of Namibia, Namibia
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Internal Validation of the Predictive Performance of Models Based on Three ED and ICU Scoring Systems to Predict Inhospital Mortality for Intensive Care Patients Referred from the Emergency Department. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3964063. [PMID: 35509709 PMCID: PMC9060993 DOI: 10.1155/2022/3964063] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022]
Abstract
Background.A variety of scoring systems have been introduced for use in both the emergency department (ED) such as WPS, REMS, and MEWS and the intensive care unit (ICU) such as APACHE II, SAPS II, and SOFA for risk stratification and mortality prediction. However, the performance of these models in the ICU remains unclear and we aimed to evaluate and compare their performance in the ICU. Methods. This multicenter retrospective cohort study was conducted on severely ill patients admitted to the ICU directly from the ED in seven tertiary hospitals in Iran from August 2018 to August 2020. We evaluated all models in terms of discrimination (AUROC), the balance between positive predictive value and sensitivity (AUPRC), calibration (Hosmer-Lemeshow test and calibration plots), and overall performance using the Brier score (BS). The endpoint was considered inhospital mortality. Results. Among the 3,455 patients included in the study, 54.4% of individuals were male (
) and 26.5% deceased (
). The BS for the WPS, REMS, MEWS, APACHE II, SAPS II, and SOFA were 0.178, 0.165, 0.183, 0.157, 0.170, and 0.182, respectively. The AUROC of these models were 0.728 (0.71-0.75), 0.761 (0.74-0.78), 0.682 (0.66-0.70), 0.810 (0.79-0.83), 0.767 (0.75-0.79), and 0.785 (0.77-0.80), respectively. The AUPRC was 0.517 (0.50-0.53) for WPS, 0.547 (0.53-0.56) for REMS, 0.445 (0.42-0.46) for MEWS, 0.630 (0.61-0.65) for APACHE II, 0.559 (0.54-0.58) for SAPS II, and 0.564 (0.54-0.57) for SOFA. All models except the MEWS and SOFA had good calibration. The most accurate model belonged to APACHE II with lowest BS. Conclusion. The APACHE II outperformed all the ED and ICU models and was found to be the most appropriate model in predicting inhospital mortality of patients in the ICU in terms of discrimination, calibration, and accuracy of predicted probability. Except for MEWS, the rest of the models had fair discrimination and partially good calibration. Interestingly, although the REMS is less complicated than the SAPS II, both models exhibited similar performance. Clinicians can utilize the REMS as part of a larger clinical assessment to manage patients more effectively.
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Kahindo CK, Mukuku O, Wembonyama SO, Tsongo ZK. Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature. Int J Nephrol 2022; 2022:5621665. [PMID: 35342649 PMCID: PMC8941586 DOI: 10.1155/2022/5621665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) is a complex condition that can occur in both community and hospital settings and has many aetiologies. These aetiologies may be infectious, toxic, surgical, or related to the different management methods. Although it is a major public health problem worldwide, it must be emphasised that both its incidence and mortality rate appear to be very high in sub-Saharan African (SSA) countries compared to developed countries. The profile of AKI is very different from that of more developed countries. There are no reliable statistics on the incidence of AKI in SSA. Infections (malaria, HIV, diarrhoeal, and other diseases), nephrotoxins, and obstetric and surgical complications are the main aetiologies in Africa. The management of AKI is costly and associated with high rates of prolonged hospitalisation and in-hospital mortality.
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Affiliation(s)
- Charles Kangitsi Kahindo
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Clinique Internationnale de Medecine Avancee au Kivu, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Fathi M, Moghaddam NM, Jahromi SN. A prognostic model for 1-month mortality in the postoperative intensive care unit. Surg Today 2021; 52:795-803. [PMID: 34698938 DOI: 10.1007/s00595-021-02391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSES Recognizing which patients admitted postsurgically to the intensive care unit (ICU) are at greater risk of mortality assists medical staff to identify who will benefit most from the care. We developed a prediction model for the 1-month mortality of postsurgical ICU patients. METHODS From May, 2019 to May, 2020, we conducted a prospective cohort study in the postsurgical ICU of a teaching hospital affiliated with our University of Medical Sciences. The outcome was death within 1 month of admission and the predictors were a variety of anthropometric and clinical features. The subjects of this analysis were 805 consecutive adult postsurgical patients with a mean (SD) age of 54.8 (18.9) years. RESULTS Overall, the resulted logistic model was well-fitted [χ2 (26) = 772.097, p < 0.001, Nagelkerke R2 = 0.814] accurate (88%), and specific (92%). The adjusted odds ratio for body temperature was 0.51, p < 0.001. Patients with comorbidities and those undergoing multiple operations were at a greater risk of mortality, odds = 10.00 and 10.65 (both p < 0.001). CONCLUSIONS Higher body temperature at the time of postoperative ICU admission is a protective factor against 1-month mortality. Our study found that patients with several comorbidities and those who have undergone multiple operations are at a greater risk of a poor outcome.
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Affiliation(s)
- Mohammad Fathi
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Markazi Moghaddam
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Shahid Etemadzadeh St., Western Fatemi, Tehran, 1411718541, Iran.
| | - Saba Naderian Jahromi
- Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran
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Kellum JA, van Till JWO, Mulligan G. Targeting acute kidney injury in COVID-19. Nephrol Dial Transplant 2020; 35:1652-1662. [PMID: 33022712 PMCID: PMC7665651 DOI: 10.1093/ndt/gfaa231] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
As of 15 August 2020, Coronavirus disease 2019 (COVID-19) has been reported in >21 million people world-wide and is responsible for more than 750,000 deaths. The occurrence of acute kidney injury (AKI) in patients hospitalized with COVID-19 has been reported to be as high as 43%. This is comparable to AKI in other forms of pneumonia requiring hospitalization, as well as in non-infectious conditions like cardiac surgery. The impact of AKI on COVID-19 outcomes is difficult to assess at present but, similar to other forms of sepsis, AKI is strongly associated with hospital mortality. Indeed, mortality is reported to be very low in COVID-19 patients without AKI. Given that AKI contributes to fluid and acid-base imbalances, compromises immune response and may impair resolution of inflammation, it seems likely that AKI contributes to mortality in these patients. The pathophysiologic mechanisms of AKI in COVID-19 are thought to be multifactorial including systemic immune and inflammatory responses induced by viral infection, systemic tissue hypoxia, reduced renal perfusion, endothelial damage and direct epithelial infection with Severe Acute Respiratory Syndrome Coronavirus 2. Mitochondria play a central role in the metabolic deregulation in the adaptive response to the systemic inflammation and are also found to be vital in response to both direct viral damage and tissue reperfusion. These stress conditions are associated with increased glycolysis and reduced fatty acid oxidation. Thus, there is a strong rationale to target AKI for therapy in COVID-19. Furthermore, many approaches that have been developed for other etiologies of AKI such as sepsis, inflammation and ischemia-reperfusion, have relevance in the treatment of COVID-19 AKI and could be rapidly pivoted to this new disease.
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Affiliation(s)
- John A Kellum
- Department of Critical Care Medicine, The Center for Critical Care Nephology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Oliveros H, Buitrago G. Effect of renal support therapy on 5-year survival in patients discharged from the intensive care unit. J Intensive Care 2020; 8:63. [PMID: 32832092 PMCID: PMC7437019 DOI: 10.1186/s40560-020-00481-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/10/2020] [Indexed: 01/12/2023] Open
Abstract
Background Between 30 and 70% of patients admitted to the intensive care unit (ICU) have acute kidney injury (AKI), and 10% of these patients will require renal replacement therapy (RRT). A significant number of studies have compared the mortality of patients who require RRT versus those who do not require it, finding an increase in mortality rates in the short and medium term; however, few studies have evaluated the long-term survival in a mixture of patients admitted to the ICU. Objective To evaluate the impact of RRT on 5-year survival in patients with AKI admitted to the ICU. Methods Using administrative databases of insurers of the Colombian health system, a cohort of patients admitted to the ICU between 1 January 2012 and 31 December 2013 was followed until 31 December 2018. ICD-10 diagnoses, procedure codes, and prescribed medications were used to establish the frequencies of the comorbidities included in the Charlson index. Patients were followed for at least 5 years to evaluate survival and establish the adjusted risks by propensity score matching. Results Of the 150,230 patients admitted to the ICU, 4366 (2.9%) required RRT in the ICU. Mortality rates for patients with RRT vs no RRT evaluated at ICU discharge, 1 year, and 5 years were 35%, 57.4%, and 67.9% vs 7.4%, 17.6%, and 30.1%, respectively. After propensity score matching, the hazard ratio was calculated for patients who received RRT and those who did not (HR, 2.46; 95% CI 2.37 to 2.56; p < 0.001), with a lower difference in years of survival for patients with RRT (mean effect in the treated) of - 1.86 (95% CI - 2.01 to to1.65; p < 0.001). Conclusions The impact of acute renal failure with the consequent need for RRT in patients admitted to the ICU is reflected in a decrease of approximately one quarter in 5-year survival, regardless of the different comorbidities.
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Affiliation(s)
- Henry Oliveros
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia.,School of Medicine, Universidad de la Sabana, Autonorte de Bogota Km 7, La Caro, Chía, Colombia
| | - Giancarlo Buitrago
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
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