Long-term prognosis of acute renal failure managed in the intensive care unit

Acute kidney injury (AKI) is associated with worse outcome in the intensive care unit (ICU). Many studies showed associations between AKI and long-term mortality, development or progression of chronic kidney disease (CKD). Experimental data support the clinical observations of relationships between AKI and CKD. Hyperfiltration induced with reduction in nephron number, insufficiency vascular and epithelial cell cycle disruption appear to represent major factors in the progression of chronic renal disease. The mortality of ICU patients with AKI is estimated at 50% in the first year and 70% at 5 years. After AKI with renal replacement therapy, the risk of end-stage renal disease in 5 years is increased by 6. Epidemiological data show clearly the impact of AKI on long-term outcome of ICU patients. Prospective clinical trials are needed to identify which AKI patients in ICU are most likely to develop CKD in order to slow the progression of renal lesion by follow-up nephrologic care.