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Survive or thrive after ICU: what’s the score?

Survive or thrive after ICU: what’s the score? McNicholas et al. Annals of Intensive Care (2023) 13:43 Annals of Intensive Care https://doi.org/10.1186/s13613-023-01140-x Open Access LE T TER TO THE EDITOR 1* 2,3 4 Bairbre A. McNicholas , Ryan Haines and Marlies Ostermann AKI is a frequent complication in critically ill patients generally 0.80–0.85 [3] and the median index value in this and portends poor short and long-term outcomes, study was 0.67 (IQR 0.40 to 1.00). Interestingly, HRQOL including an increase in readmissions, cardiovascular scores were not influenced by need for chronic dialysis. events, and progression to chronic kidney disease (CKD) These findings are consistent with a body of literature [1]. The impact on health related quality of life (HRQOL) that was summarized in a comprehensive meta-anal- has been studied less. Further, it is not known which ysis published in 2014 [3]. The meta-analysis included aspects of HRQOL are most affected and why, and how 18 studies over a 18  year period in which six different this could shape post-critical care management. Some HRQOL assessment tools (SF-46, EQ-5L, NHP, HUI3, of these questions have been addressed in the follow-up MOS-SF-20, SF-12) were used and assessments were study of The Artificial Kidney Initiation in Kidney Injury made over a median of 10.5  months ranging from 2 to (AKIKI) trial by Chaibi et al. [2]. 14  years after ICU admission [3]. Overall, HRQOL was AKIKI was a large French multicentre randomised markedly impaired among survivors of AKI compared controlled trial on renal replacement therapy (RRT) to the general population and this was mainly driven by initiation strategy for AKI [2]. Chaibi et  al. examined limitations in physical function, mobility and ambulation longer-term survival, renal outcomes and HRQOL in 316 compared to psychosocial domains. Interestingly, the patients (51% of total population) who survived 60  days majority of studies found a similar degree of reduction in after randomization. Their median follow-up was up to HRQOL in patients experiencing AKI or receiving RRT 3.35  years [Interquartile range (IQR) 1.89—4.09]. Sur- when compared to similarly critically ill patients without vival rate was 39.4% at three years following inclusion, severe AKI. Notably, at 1 year post ICU admission, more with age being the only predictor om mortality. Over a than 80% of respondents would undergo ICU admission quarter of patients had worsening renal function whilst again if needed to survive [4]. 5% needed chronic dialysis. HRQOL was assessed using Since that publication, several other studies have exam- the Eq-5L instrument at a median of 3  years post ran- ined HRQOL outcomes with similar findings (Table  1). domisation. Although the response rate was low at 35%, Further, additional scoring systems have been intro- overall HRQOL following an ICU admission with AKI duced, notably the clinical frailty score (CFS). Frailty, was low. Population normative data for the EQ-index is although more common with age but not confined to the elderly, complicates acute and chronic disease and is considered a marker of a limited existence [5]. It can be *Correspondence: assessed using the CFS, a validated measure of clinical Bairbre A. McNicholas frailty with scores ranging from 1 (very fit) to 7 (severely bmcnicholas@universityofgalway.ie 1 dependent). There are recognized limits to the CFS, Department of Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway H91 YR71, Ireland and although not a classic HRQOL scoring system, it is Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS objective, easy to obtain and easy to teach [6]. In a pro- Trust, London, UK 3 spective multicentre observational study enrolling older William Harvey Research Institute, Queen Mary University of London, London, UK critically ill patients with AKI, frailty was defined as hav - Department of Intensive Care, King’s College London, Guy’s and St ing a CFS > 5. The study found 28% of survivors were con - Thomas’ Hospital, London, UK sidered frail at 6  months, of whom 57% were not back © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. McNicholas et al. Annals of Intensive Care (2023) 13:43 Page 2 of 5 Table 1 Selected studies exploring quality of life and frailty in AKI survivors Study Location Years of enrolment Design AKI population QOL or Frailty Instrument Assessment time Comments/Main questionnaire point findings Response rate / total population Soliman et al. [7] Netherlands July 2009 until April Single center retro- Patients with early 1020 / 1549 (65.8%) EuroQoL 5D-3L 1 year All AKI categories 2013 spective analysis RIFLE AKI in ICU and (EQ-5D) were associated with alive at 1 year a primary outcome of EQ-5L < 0.4 or death but at 1 year, AKI cat- egory was not associ- ated with HRQOL Salathe et al. [9] Switzerland January 2015 until Single site observa- All patients > 55 who 83/119 (69.7%) EQ-5D with VAS VAS score was 71 April 2018 tional study received RRT for AKI (SD 22) and mean and were alive in EQ-5D derived health May 2019 utility 0.76 (IQR 0.26). Pain was the most frequently reported limitation (46.9%), followed by mobility (36.1%) and anxiety (21.6%); Scores were significantly lower in patients older than 75 years compared to younger patients; QOL was significantly lower than an age/sex matched reference population Thanapongsatorn Thailand August 2018 to Randomised con- Severe AKI stage 78/98 (79%) EQ-5D-5L 1 year No statistically sig- et al. [10] January 2021 trolled trial 2–3 and alive at nificant difference in 12 months EQ-5D-5L index scores between the comprehensive care and control group (0.99 [0.8–1.0] vs 0.96 [0.8–1.0], p = 0.80) M cNicholas et al. Annals of Intensive Care (2023) 13:43 Page 3 of 5 Table 1 (continued) Study Location Years of enrolment Design AKI population QOL or Frailty Instrument Assessment time Comments/Main questionnaire point findings Response rate / total population Mishra et al. [11] United Kingdom January 2005 until Observational Patients with RIFLE 499/777 (64%) SF-12 v2) At least 1 year Median follow-up for December 2011 cohort study –I or higher AKI post patients who returned cardiac surgery and the QOL alive at least 1 year questionnaires were post surgery 60 months (30, 113) for the AKI group and 63 months (30, 112) for non-AKI patients. Mental scores were not significantly dif- ferent (51.0 [18.5, 70.8] vs. 52.2 [21.8, 70.6], P = 0.2) between both groups but the physi- cal scores were (38.8 [14.2, 62.5] vs. 44.2 [13.8, 76.7], P< 0.01) Studies examining clinical frailty score post AKI Beaubien-Souligny Canada September 2013 Multicentre ICU 243 / 499 at CFS At baseline,90 days Frailty was indepen- et al. [5] until November prospective cohort patients ≥ 65 years 6 months (87%) and 6 months dently 2015 study at 6 and with severe AKI and 216 / 499 at associated with 12 months alive at 90 days 12 months (81%) 90-day mortality (adjusted HR 1.49; 95% CI 1.11–2.01, p = 0.008); 243 (53%) patients were alive and had CFS scores captured. Among these, 68 (28%) were frail including 39 (57%) patients who were not frail at baseline McNicholas et al. Annals of Intensive Care (2023) 13:43 Page 4 of 5 Table 1 (continued) Study Location Years of enrolment Design AKI population QOL or Frailty Instrument Assessment time Comments/Main questionnaire point findings Response rate / total population Abdel-Kader et al. [6] USA 2007 to 2010 Prospective cohort Critically ill adults 317/371 at 3 months CFS Baseline 3 and Peak AKI was gener- study in 5 US medi- with acute respira- (85%) 12 months ally associated with cal centers tory failure and/or 318/371 at higher CFS scores at septic or cardio- 12 months (86%) 12 months (AKI stage genic shock and 1: OR 1.87, 95% CI KDGIO-AKI 1.11, 3.14; AKI stage 2: OR 1.81, 95% CI 0.94, 3.48; AKI stage 3: OR 2.76, 95% CI 1.34, 5.66) AKI acute kidney injury, HR hazard ratio, RIFLE Risk–Injury–Failure–Loss–End-stage, RRT renal replacement therapy, VAS visual analog scale, IQR interquartile range, CFS clinical frailty score, QOL quality of life, KDIGO Kidney Disease Improving Global Outcomes, OR odds ratio, CI Confidence interval M cNicholas et al. Annals of Intensive Care (2023) 13:43 Page 5 of 5 Declarations at baseline (pre-ICU level) with only 4% transitioning to not frail and a further 4% becoming frail [5]. A follow- Ethics approval and consent to participate up of the BRAIN ICU study, a prospective cohort of criti- Not applicable. cally ill adults with acute respiratory failure and/or shock Consent for publication enrolled found that severity of AKI was associated with Not applicable. increasing frailty at both 3 and 12  months compared to Competing interests baseline measurements [6]. These studies further corrob - The authors declare no competing interests. orate the ongoing decline in physical function of patients who suffer AKI as part of their critical illness. They also Received: 27 April 2023 Accepted: 6 May 2023 highlight the link between frailty and HRQOL and the complexity of assessing HRQOL specifically related to survival after AKI. There are additional limitations to interpreting References HRQOL data following critical illness. First, the find - 1. Hsu CY, Chinchilli VM, Coca S, et al. Post-acute kidney injury proteinuria ings are impacted by the heterogeneity in study design and subsequent kidney disease progression: the assessment, serial and participants, timing of assessment, and tools used. evaluation, and subsequent sequelae in acute kidney injury (ASSESS-AKI) study. JAMA Intern Med. 2020;180(3):402–10. Second, most studies reported a high loss to follow-up 2. Chaibi K, Ehooman F, Pons B, et al. Long-term outcomes after severe [3]. Despite this, there are useful signals, including the acute kidney injury in critically ill patients: the SALTO study. Ann Intensive absence of difference in HRQOL based on stage of AKI Care. 2023;13(1):18. 3. Villeneuve PM, Clark EG, Sikora L, Sood MM, Bagshaw SM. Health-related or implementation of acute RRT [3, 6, 7]. This suggests quality-of-life among survivors of acute kidney injury in the intensive care that the process that led to AKI drives ongoing worse unit: a systematic review. Intensive Care Med. 2016;42(2):137–46. outcomes rather than AKI per se. More recently, worse 4. Oeyen S, De Corte W, Benoit D, et al. Long-term quality of life in critically ill patients with acute kidney injury treated with renal replacement cardiovascular outcomes have been reported for patients therapy: a matched cohort study. Crit Care. 2015;19(1):289. who survive AKI during hospitalisation, particularly 5. Beaubien-Souligny W, Yang A, Lebovic G, Wald R, Bagshaw SM. Frailty in those with increased proteinuria [1]. Measuring and status among older critically ill patients with severe acute kidney injury. Crit Care. 2021;25(1):84. monitoring such outcomes provide valuable data of the 6. Abdel-Kader K, Girard TD, Brummel NE, et al. Acute kidney injury and sub- long-term effects of AKI. However, the day to day effects sequent frailty status in survivors of critical illness: a secondary analysis. long after ICU admission are less well studied, nor how Crit Care Med. 2018;46(5):e380–8. 7. Soliman IW, Frencken JF, Peelen LM, et al. The predictive value of early the effects of changing socio-economic status following acute kidney injury for long-term survival and quality of life of critically ill critical care influence HRQOL measurements at the time patients. Crit Care. 2016;20(1):242. of testing [8]. 8. Falvey JR, Murphy TE, Leo-Summers L, Gill TM, Ferrante LE. Neighborhood socioeconomic disadvantage and disability after critical illness. Crit Care The study by Chaibi and colleagues provides impor - Med. 2022;50(5):733–41. tant data to our field on how patients survive after criti - 9. Salathe C, Poli E, Altarelli M, Bianchi NA, Schneider AG. Epidemiology and cal illness. However, it is unclear how these results should outcomes of elderly patients requiring renal replacement therapy in the intensive care unit: an observational study. BMC Nephrol. 2021;22(1):101. influence clinical management. Should rehabilitation, 10. Thanapongsatorn P, Chaikomon K, Lumlertgul N, et al. Comprehensive optimisation of nutrition and psychosocial support to versus standard care in post-severe acute kidney injury survivors, a rand- reduce frailty be as much part of follow-up care after omized controlled trial. Crit Care. 2021;25(1):322. 11. Mishra PK, Luckraz H, Nandi J, et al. Long-term quality of life posta- AKI as measuring urinary albumin and serum creatinine? cute kidney injury in cardiac surgery patients. Ann Card Anaesth. The study by Chaibi et al. serves as a reminder that more 2018;21(1):41–5. research in AKI survivors is urgently needed to inform management strategies so that patients with AKI do not Publisher’s Note just survive but thrive after ICU. Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations. Acknowledgements None. Author contributions BM, MO and RH conceived letter, drafted and edited manuscript. All authors read and approved final manuscript. Funding None. Availability of data and materials Not applicable. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Intensive Care Springer Journals

Survive or thrive after ICU: what’s the score?

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Abstract

McNicholas et al. Annals of Intensive Care (2023) 13:43 Annals of Intensive Care https://doi.org/10.1186/s13613-023-01140-x Open Access LE T TER TO THE EDITOR 1* 2,3 4 Bairbre A. McNicholas , Ryan Haines and Marlies Ostermann AKI is a frequent complication in critically ill patients generally 0.80–0.85 [3] and the median index value in this and portends poor short and long-term outcomes, study was 0.67 (IQR 0.40 to 1.00). Interestingly, HRQOL including an increase in readmissions, cardiovascular scores were not influenced by need for chronic dialysis. events, and progression to chronic kidney disease (CKD) These findings are consistent with a body of literature [1]. The impact on health related quality of life (HRQOL) that was summarized in a comprehensive meta-anal- has been studied less. Further, it is not known which ysis published in 2014 [3]. The meta-analysis included aspects of HRQOL are most affected and why, and how 18 studies over a 18  year period in which six different this could shape post-critical care management. Some HRQOL assessment tools (SF-46, EQ-5L, NHP, HUI3, of these questions have been addressed in the follow-up MOS-SF-20, SF-12) were used and assessments were study of The Artificial Kidney Initiation in Kidney Injury made over a median of 10.5  months ranging from 2 to (AKIKI) trial by Chaibi et al. [2]. 14  years after ICU admission [3]. Overall, HRQOL was AKIKI was a large French multicentre randomised markedly impaired among survivors of AKI compared controlled trial on renal replacement therapy (RRT) to the general population and this was mainly driven by initiation strategy for AKI [2]. Chaibi et  al. examined limitations in physical function, mobility and ambulation longer-term survival, renal outcomes and HRQOL in 316 compared to psychosocial domains. Interestingly, the patients (51% of total population) who survived 60  days majority of studies found a similar degree of reduction in after randomization. Their median follow-up was up to HRQOL in patients experiencing AKI or receiving RRT 3.35  years [Interquartile range (IQR) 1.89—4.09]. Sur- when compared to similarly critically ill patients without vival rate was 39.4% at three years following inclusion, severe AKI. Notably, at 1 year post ICU admission, more with age being the only predictor om mortality. Over a than 80% of respondents would undergo ICU admission quarter of patients had worsening renal function whilst again if needed to survive [4]. 5% needed chronic dialysis. HRQOL was assessed using Since that publication, several other studies have exam- the Eq-5L instrument at a median of 3  years post ran- ined HRQOL outcomes with similar findings (Table  1). domisation. Although the response rate was low at 35%, Further, additional scoring systems have been intro- overall HRQOL following an ICU admission with AKI duced, notably the clinical frailty score (CFS). Frailty, was low. Population normative data for the EQ-index is although more common with age but not confined to the elderly, complicates acute and chronic disease and is considered a marker of a limited existence [5]. It can be *Correspondence: assessed using the CFS, a validated measure of clinical Bairbre A. McNicholas frailty with scores ranging from 1 (very fit) to 7 (severely bmcnicholas@universityofgalway.ie 1 dependent). There are recognized limits to the CFS, Department of Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway H91 YR71, Ireland and although not a classic HRQOL scoring system, it is Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS objective, easy to obtain and easy to teach [6]. In a pro- Trust, London, UK 3 spective multicentre observational study enrolling older William Harvey Research Institute, Queen Mary University of London, London, UK critically ill patients with AKI, frailty was defined as hav - Department of Intensive Care, King’s College London, Guy’s and St ing a CFS > 5. The study found 28% of survivors were con - Thomas’ Hospital, London, UK sidered frail at 6  months, of whom 57% were not back © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. McNicholas et al. Annals of Intensive Care (2023) 13:43 Page 2 of 5 Table 1 Selected studies exploring quality of life and frailty in AKI survivors Study Location Years of enrolment Design AKI population QOL or Frailty Instrument Assessment time Comments/Main questionnaire point findings Response rate / total population Soliman et al. [7] Netherlands July 2009 until April Single center retro- Patients with early 1020 / 1549 (65.8%) EuroQoL 5D-3L 1 year All AKI categories 2013 spective analysis RIFLE AKI in ICU and (EQ-5D) were associated with alive at 1 year a primary outcome of EQ-5L < 0.4 or death but at 1 year, AKI cat- egory was not associ- ated with HRQOL Salathe et al. [9] Switzerland January 2015 until Single site observa- All patients > 55 who 83/119 (69.7%) EQ-5D with VAS VAS score was 71 April 2018 tional study received RRT for AKI (SD 22) and mean and were alive in EQ-5D derived health May 2019 utility 0.76 (IQR 0.26). Pain was the most frequently reported limitation (46.9%), followed by mobility (36.1%) and anxiety (21.6%); Scores were significantly lower in patients older than 75 years compared to younger patients; QOL was significantly lower than an age/sex matched reference population Thanapongsatorn Thailand August 2018 to Randomised con- Severe AKI stage 78/98 (79%) EQ-5D-5L 1 year No statistically sig- et al. [10] January 2021 trolled trial 2–3 and alive at nificant difference in 12 months EQ-5D-5L index scores between the comprehensive care and control group (0.99 [0.8–1.0] vs 0.96 [0.8–1.0], p = 0.80) M cNicholas et al. Annals of Intensive Care (2023) 13:43 Page 3 of 5 Table 1 (continued) Study Location Years of enrolment Design AKI population QOL or Frailty Instrument Assessment time Comments/Main questionnaire point findings Response rate / total population Mishra et al. [11] United Kingdom January 2005 until Observational Patients with RIFLE 499/777 (64%) SF-12 v2) At least 1 year Median follow-up for December 2011 cohort study –I or higher AKI post patients who returned cardiac surgery and the QOL alive at least 1 year questionnaires were post surgery 60 months (30, 113) for the AKI group and 63 months (30, 112) for non-AKI patients. Mental scores were not significantly dif- ferent (51.0 [18.5, 70.8] vs. 52.2 [21.8, 70.6], P = 0.2) between both groups but the physi- cal scores were (38.8 [14.2, 62.5] vs. 44.2 [13.8, 76.7], P< 0.01) Studies examining clinical frailty score post AKI Beaubien-Souligny Canada September 2013 Multicentre ICU 243 / 499 at CFS At baseline,90 days Frailty was indepen- et al. [5] until November prospective cohort patients ≥ 65 years 6 months (87%) and 6 months dently 2015 study at 6 and with severe AKI and 216 / 499 at associated with 12 months alive at 90 days 12 months (81%) 90-day mortality (adjusted HR 1.49; 95% CI 1.11–2.01, p = 0.008); 243 (53%) patients were alive and had CFS scores captured. Among these, 68 (28%) were frail including 39 (57%) patients who were not frail at baseline McNicholas et al. Annals of Intensive Care (2023) 13:43 Page 4 of 5 Table 1 (continued) Study Location Years of enrolment Design AKI population QOL or Frailty Instrument Assessment time Comments/Main questionnaire point findings Response rate / total population Abdel-Kader et al. [6] USA 2007 to 2010 Prospective cohort Critically ill adults 317/371 at 3 months CFS Baseline 3 and Peak AKI was gener- study in 5 US medi- with acute respira- (85%) 12 months ally associated with cal centers tory failure and/or 318/371 at higher CFS scores at septic or cardio- 12 months (86%) 12 months (AKI stage genic shock and 1: OR 1.87, 95% CI KDGIO-AKI 1.11, 3.14; AKI stage 2: OR 1.81, 95% CI 0.94, 3.48; AKI stage 3: OR 2.76, 95% CI 1.34, 5.66) AKI acute kidney injury, HR hazard ratio, RIFLE Risk–Injury–Failure–Loss–End-stage, RRT renal replacement therapy, VAS visual analog scale, IQR interquartile range, CFS clinical frailty score, QOL quality of life, KDIGO Kidney Disease Improving Global Outcomes, OR odds ratio, CI Confidence interval M cNicholas et al. Annals of Intensive Care (2023) 13:43 Page 5 of 5 Declarations at baseline (pre-ICU level) with only 4% transitioning to not frail and a further 4% becoming frail [5]. A follow- Ethics approval and consent to participate up of the BRAIN ICU study, a prospective cohort of criti- Not applicable. cally ill adults with acute respiratory failure and/or shock Consent for publication enrolled found that severity of AKI was associated with Not applicable. increasing frailty at both 3 and 12  months compared to Competing interests baseline measurements [6]. These studies further corrob - The authors declare no competing interests. orate the ongoing decline in physical function of patients who suffer AKI as part of their critical illness. They also Received: 27 April 2023 Accepted: 6 May 2023 highlight the link between frailty and HRQOL and the complexity of assessing HRQOL specifically related to survival after AKI. There are additional limitations to interpreting References HRQOL data following critical illness. First, the find - 1. Hsu CY, Chinchilli VM, Coca S, et al. Post-acute kidney injury proteinuria ings are impacted by the heterogeneity in study design and subsequent kidney disease progression: the assessment, serial and participants, timing of assessment, and tools used. evaluation, and subsequent sequelae in acute kidney injury (ASSESS-AKI) study. JAMA Intern Med. 2020;180(3):402–10. Second, most studies reported a high loss to follow-up 2. Chaibi K, Ehooman F, Pons B, et al. Long-term outcomes after severe [3]. Despite this, there are useful signals, including the acute kidney injury in critically ill patients: the SALTO study. Ann Intensive absence of difference in HRQOL based on stage of AKI Care. 2023;13(1):18. 3. Villeneuve PM, Clark EG, Sikora L, Sood MM, Bagshaw SM. Health-related or implementation of acute RRT [3, 6, 7]. This suggests quality-of-life among survivors of acute kidney injury in the intensive care that the process that led to AKI drives ongoing worse unit: a systematic review. Intensive Care Med. 2016;42(2):137–46. outcomes rather than AKI per se. More recently, worse 4. Oeyen S, De Corte W, Benoit D, et al. Long-term quality of life in critically ill patients with acute kidney injury treated with renal replacement cardiovascular outcomes have been reported for patients therapy: a matched cohort study. Crit Care. 2015;19(1):289. who survive AKI during hospitalisation, particularly 5. Beaubien-Souligny W, Yang A, Lebovic G, Wald R, Bagshaw SM. Frailty in those with increased proteinuria [1]. Measuring and status among older critically ill patients with severe acute kidney injury. Crit Care. 2021;25(1):84. monitoring such outcomes provide valuable data of the 6. Abdel-Kader K, Girard TD, Brummel NE, et al. Acute kidney injury and sub- long-term effects of AKI. However, the day to day effects sequent frailty status in survivors of critical illness: a secondary analysis. long after ICU admission are less well studied, nor how Crit Care Med. 2018;46(5):e380–8. 7. Soliman IW, Frencken JF, Peelen LM, et al. The predictive value of early the effects of changing socio-economic status following acute kidney injury for long-term survival and quality of life of critically ill critical care influence HRQOL measurements at the time patients. Crit Care. 2016;20(1):242. of testing [8]. 8. Falvey JR, Murphy TE, Leo-Summers L, Gill TM, Ferrante LE. Neighborhood socioeconomic disadvantage and disability after critical illness. Crit Care The study by Chaibi and colleagues provides impor - Med. 2022;50(5):733–41. tant data to our field on how patients survive after criti - 9. Salathe C, Poli E, Altarelli M, Bianchi NA, Schneider AG. Epidemiology and cal illness. However, it is unclear how these results should outcomes of elderly patients requiring renal replacement therapy in the intensive care unit: an observational study. BMC Nephrol. 2021;22(1):101. influence clinical management. Should rehabilitation, 10. Thanapongsatorn P, Chaikomon K, Lumlertgul N, et al. Comprehensive optimisation of nutrition and psychosocial support to versus standard care in post-severe acute kidney injury survivors, a rand- reduce frailty be as much part of follow-up care after omized controlled trial. Crit Care. 2021;25(1):322. 11. Mishra PK, Luckraz H, Nandi J, et al. Long-term quality of life posta- AKI as measuring urinary albumin and serum creatinine? cute kidney injury in cardiac surgery patients. Ann Card Anaesth. The study by Chaibi et al. serves as a reminder that more 2018;21(1):41–5. research in AKI survivors is urgently needed to inform management strategies so that patients with AKI do not Publisher’s Note just survive but thrive after ICU. Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations. Acknowledgements None. Author contributions BM, MO and RH conceived letter, drafted and edited manuscript. All authors read and approved final manuscript. Funding None. Availability of data and materials Not applicable.

Journal

Annals of Intensive CareSpringer Journals

Published: May 19, 2023

There are no references for this article.