Evoluation of the effect of acute kidney injury on weaning in intensive care unit patients

Introduction: Acute kidney injury (AKI), which is seen in 5 to 30 % of intensive care unit patients, remains as a big problem that leading to higher mortality rate (40 - 90 %.), longer stay in ICU, and increased need for high cost treatment modalities such dialysis. Recent studies were done to highlight the association between lung injury and kidney injury. However, very few of them evaluated the effect of acute kidney injury on weaning from mechanical ventilation. In this study, we aim to evaluate the effect of acute kidney injury on weaning in intensive care unit patients. Material and methods: Patients followed in the intensive care unit of deparment of internal medicine between period of 2010 and 2016 in Dicle University Faculty of Medicine were selected in this study. Acute kidney injury diagnosis were done according to KDIGO guideline criterias. Patients with chronic kidney disease, chronic lung disease and heart failure were excluded from the study. Respiratory failure being intubated at least for 48 hours was inclusion criteria. 100 patients with acute kidney injury and 100 patients without acute kidney injury meeting these criterias were compared. Patients age, gender, creatinine, albümin, SOFA score, APACHE II score, hemoglobin level, oxygene saturation, partial oxygene and carbondioxide pressure, pH and presence of sepsis or not were evaluated. Results: In all patients, gender distribution with % 58,5 of male % 41,5 of female, weaning was done in 23 %, which in AKI group was 13% (13/100), and in non-AKI group was %43 (43/100) (p < 0.001). In the patients weaned from mechanical ventilation, creatinine levels were lower (creatinine; 1,35+ 1,39 vs 2,10 + 1.42, mg/dl; p = 0.001), as well as APACHE II and SOFA score (p < 0.001). In multiple logistic regression analysis, weaning rate was found to be higher in the absence of acute kidney injury ( predicted relative risk:4,95 – Confidence interval :2,41-10,16 - p<0,001). Conclusion: Our study showed a strong association between acute kidney injury and respiratory system in intensive care unit patients following intubated. Acute kidney injury was found to have a negative effect on weaning from mecnanical ventilation. Thus, in this population, early recognition of acute kidney injury may play an important role in determining the prognosis and other clinical approaches. Keywords: Acute kidney injury, mechanic ventilation, weaning, respiratory failure