Prognostic implications of the duration of continuous kidney replacement therapy in 3-month survivors of acute kidney injury: findings from the LINKA cohort
10 affiliations
- 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
- 2Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
- 3Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
- 4Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- 5Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- 6Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
- 7Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- 8Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- 9Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary’s Hospital, Seoul, Republic of Korea
- 10Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
Abstract
Background: The duration of continuous kidney replacement therapy (CKRT) represents a complex clinical surrogate reflecting the severity of systemic illness, the rate of metabolic recovery, and clinical decision-making regarding treatment discontinuation. The effect of CKRT duration on long-term outcomes in patients with acute kidney injury (AKI) is unclear. This study aimed to identify factors associated with CKRT duration and evaluate its association with long-term renal outcomes and mortality.
Methods: This multicenter, retrospective study included 1,436 patients with AKI who received CKRT between 2017 and 2022 and survived ≥ 3 months post-initiation. Participants were stratified into groups based on the median CKRT duration: short (≤ 4 days) or long duration (> 4 days). Multivariable logistic regression examined the factors associated with CKRT duration. Multivariable Cox proportional hazards regression evaluated the effect of CKRT duration on the risk of end-stage kidney disease (ESKD) and all-cause mortality. The incremental predictive value of CKRT duration beyond traditional clinical variables and the Sequential Organ Failure Assessment (SOFA) score was evaluated using differences in Harrell’s concordance index (ΔC-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Results: The use of mechanical ventilation (adjusted odds ratio [aOR], 2.742; 95% confidence interval [CI], 1.990 − 3.792; P < 0.001), extracorporeal membrane oxygenation (aOR, 1.983; 95% CI, 1.223 − 3.267; P = 0.006), and higher C-reactive protein levels (aOR, 1.002; 95% CI, 1.001–1.004; P = 0.009) were significant predictors of long-duration CKRT. However, higher baseline urine output (aOR, 0.998; 95% CI, 0.996–1.000; P = 0.017) and platelet counts (aOR, 0.998; 95% CI, 0.996–0.999; P = 0.009) were independently associated with short-duration CKRT. During a mean follow-up of 17.8 months and 24.6 months, 26.1% of participants progressed to ESKD and 26.6% died, respectively. After adjusting for confounders, long-duration CKRT was independently associated with a significantly higher risk of ESKD (adjusted hazard ratio [aHR], 1.598; 95% CI, 1.260–2.025; P < 0.001) and all-cause mortality (aHR, 1.631; 95% CI, 1.310–2.032; P < 0.001). Addition of CKRT duration to baseline risk models including the SOFA score significantly enhanced risk reclassification and discrimination performance for both ESKD (ΔC-index = + 0.020, P < 0.001; NRI = 30.0%, P < 0.001; IDI = 0.024, P < 0.001) and all-cause mortality (ΔC-index = + 0.037, P < 0.001; NRI = 33.0%, P < 0.001; IDI = 0.033, P = 0.030).
Conclusions: Prolonged CKRT was independently associated with an increased risk of long-term ESKD progression and all-cause mortality among 3-month survivors of AKI. Thus, the duration of CKRT may serve as a meaningful prognostic marker to identify high-risk patients who might benefit from close follow-up and tailored multidisciplinary management.
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BibTeX
@article{jung2026prognostic,
title = {{Prognostic implications of the duration of continuous kidney replacement therapy in 3-month survivors of acute kidney injury: findings from the LINKA cohort}},
author = {Hee-Yeon Jung and Junyoung Park and Donghwan Yun and Seung Seok Han and Dong Ki Kim and Jeonghwan Lee and Jung Pyo Lee and Yaerim Kim and Kyubok Jin and Ji Eun Kim and Gang-Jee Ko and Shin Young Ahn and Seokwoo Park and Sejoong Kim and Eun Sil Koh and Sungjin Chung and Jang-Hee Cho and Sun-Hee Park and Chan-Duck Kim and Yong-Lim Kim and Sung Gyun Kim and Jung Nam An},
journal = {BMC Nephrology},
year = {2026},
month = sep,
doi = {10.1186/s12882-026-05376-0},
url = {https://doi.org/10.1186/s12882-026-05376-0},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Prognostic implications of the duration of continuous kidney replacement therapy in 3-month survivors of acute kidney injury: findings from the LINKA cohort
AU - Hee-Yeon Jung
AU - Junyoung Park
AU - Donghwan Yun
AU - Seung Seok Han
AU - Dong Ki Kim
AU - Jeonghwan Lee
AU - Jung Pyo Lee
AU - Yaerim Kim
AU - Kyubok Jin
AU - Ji Eun Kim
AU - Gang-Jee Ko
AU - Shin Young Ahn
AU - Seokwoo Park
AU - Sejoong Kim
AU - Eun Sil Koh
AU - Sungjin Chung
AU - Jang-Hee Cho
AU - Sun-Hee Park
AU - Chan-Duck Kim
AU - Yong-Lim Kim
AU - Sung Gyun Kim
AU - Jung Nam An
PY - 2026
DA - 2026/09/22
JO - BMC Nephrology
DO - 10.1186/s12882-026-05376-0
UR - https://doi.org/10.1186/s12882-026-05376-0
AB - Background: The duration of continuous kidney replacement therapy (CKRT) represents a complex clinical surrogate reflecting the severity of systemic illness, the rate of metabolic recovery, and clinical decision-making regarding treatment discontinuation. The effect of CKRT duration on long-term outcomes in patients with acute kidney injury (AKI) is unclear. This study aimed to identify factors associated with CKRT duration and evaluate its association with long-term renal outcomes and mortality. Methods: This multicenter, retrospective study included 1,436 patients with AKI who received CKRT between 2017 and 2022 and survived ≥ 3 months post-initiation. Participants were stratified into groups based on the median CKRT duration: short (≤ 4 days) or long duration (> 4 days). Multivariable logistic regression examined the factors associated with CKRT duration. Multivariable Cox proportional hazards regression evaluated the effect of CKRT duration on the risk of end-stage kidney disease (ESKD) and all-cause mortality. The incremental predictive value of CKRT duration beyond traditional clinical variables and the Sequential Organ Failure Assessment (SOFA) score was evaluated using differences in Harrell’s concordance index (ΔC-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: The use of mechanical ventilation (adjusted odds ratio [aOR], 2.742; 95% confidence interval [CI], 1.990 − 3.792; P < 0.001), extracorporeal membrane oxygenation (aOR, 1.983; 95% CI, 1.223 − 3.267; P = 0.006), and higher C-reactive protein levels (aOR, 1.002; 95% CI, 1.001–1.004; P = 0.009) were significant predictors of long-duration CKRT. However, higher baseline urine output (aOR, 0.998; 95% CI, 0.996–1.000; P = 0.017) and platelet counts (aOR, 0.998; 95% CI, 0.996–0.999; P = 0.009) were independently associated with short-duration CKRT. During a mean follow-up of 17.8 months and 24.6 months, 26.1% of participants progressed to ESKD and 26.6% died, respectively. After adjusting for confounders, long-duration CKRT was independently associated with a significantly higher risk of ESKD (adjusted hazard ratio [aHR], 1.598; 95% CI, 1.260–2.025; P < 0.001) and all-cause mortality (aHR, 1.631; 95% CI, 1.310–2.032; P < 0.001). Addition of CKRT duration to baseline risk models including the SOFA score significantly enhanced risk reclassification and discrimination performance for both ESKD (ΔC-index = + 0.020, P < 0.001; NRI = 30.0%, P < 0.001; IDI = 0.024, P < 0.001) and all-cause mortality (ΔC-index = + 0.037, P < 0.001; NRI = 33.0%, P < 0.001; IDI = 0.033, P = 0.030). Conclusions: Prolonged CKRT was independently associated with an increased risk of long-term ESKD progression and all-cause mortality among 3-month survivors of AKI. Thus, the duration of CKRT may serve as a meaningful prognostic marker to identify high-risk patients who might benefit from close follow-up and tailored multidisciplinary management.
SN - 1471-2369
ER -