J Korean Med Sci.  2015 Jun;30(6):802-807. 10.3346/jkms.2015.30.6.802.

Shock Duration after Resuscitation Is Associated with Occurrence of Post-Cardiac Arrest Acute Kidney Injury

• Kim YW
• Cha KC
• Cha YS
• Kim OH
• Jung WJ
• Kim TH
• Han BK
• Kim H
• Lee KH
• Choi E
• Hwang SO

• KMID: 2160611
• DOI: http://doi.org/10.3346/jkms.2015.30.6.802

Abstract

This retrospective observational study investigated the clinical course and predisposing factors of acute kidney injury (AKI) developed after cardiac arrest and resuscitation. Eighty-two patients aged over 18 yr who survived more than 24 hr after cardiac arrest were divided into AKI and non-AKI groups according to the diagnostic criteria of the Kidney Disease/Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI. Among 82 patients resuscitated from cardiac arrest, AKI was developed in 66 (80.5%) patients (AKI group) leaving 16 (19.5%) patients in the non-AKI group. Nineteen (28.8%) patients of the AKI group had stage 3 AKI and 7 (10.6%) patients received renal replacement therapy during admission. The duration of shock developed within 24 hr after resuscitation was shorter in the non-AKI group than in the AKI group (OR 1.02, 95% CI 1.01-1.04, P < 0.05). On Multiple logistic regression analysis, the only predisposing factor of post-cardiac arrest AKI was the duration of shock. In conclusion, occurrence and severity of post-cardiac arrest AKI is associated with the duration of shock after resuscitation. Renal replacement therapy is required for patients with severe degree (stage 3) post-cardiac arrest AKI.

Keyword

Cardiac Arrest; Resuscitation; Acute Kidney Injury; Renal Failure; Heart Arrest; Post-cardiac Arrest Syndrome; Renal Replacement Therapy

MeSH Terms

Acute Kidney Injury/*mortality/*therapy
Aged
Female
Heart Arrest/*mortality/*therapy
Humans
Incidence
Male
Middle Aged
Renal Replacement Therapy/mortality
Republic of Korea/epidemiology
Resuscitation/*mortality
Retrospective Studies
Risk Factors
Severity of Illness Index
Shock/*mortality
Survival Rate
Treatment Outcome

Figure

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  Fig. 1 Trends of creatinine level in AKI group. Serum creatinine level in patients with stage 1 or 2 AKI showed a peak on the day of resuscitation from cardiac arrest and gradually declined to steady state level. Further elevation and fluctuation of serum creatinine level after resuscitation occurred in patients with stage 3 AKI. Serum creatinine measurements of the patients received renal replacement therapy were not included. AKI, acute kidney injury.

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  Fig. 2 Severity of AKI and shock duration. Duration of shock within 24 hr after resuscitation increased with the stage of AKI. AKI, acute kidney injury.

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  Fig. 3 Receiver operating characteristic curve for development of AKI. The area under the curve for shock duration was 0.815. The optimal cutoff for shock duration to predict AKI was 57 min, with respective values of 70.8% for sensitivity and 75% for specificity. AKI, acute kidney injury.

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