• Michael Darmon, Christophe Clec'h, Christophe Adrie, Laurent Argaud, Bernard Allaouchiche, Elie Azoulay, Lila Bouadma, Maïté Garrouste-Orgeas, Hakim Haouache, Carole Schwebel, Dany Goldgran-Toledano, Hatem Khallel, Anne-Sylvie Dumenil, Samir Jamali, Bertrand Souweine, Fabrice Zeni, Yves Cohen, and Jean-François Timsit.
• Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. michael.darmon@chu-st-etienne.fr.
• Clin J Am Soc Nephrol. 2014 Aug 7;9(8):1347-53.

Background And ObjectivesIncreasing experimental evidence suggests that acute respiratory distress syndrome (ARDS) may promote AKI. The primary objective of this study was to assess ARDS as a risk factor for AKI in critically ill patients.Design, Setting, Participants, & MeasurementsThis was an observational study on a prospective database fed by 18 intensive care units (ICUs). Patients with ICU stays >24 hours were enrolled over a 14-year period. ARDS was defined using the Berlin criteria and AKI was defined using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria. Patients with AKI before ARDS onset were excluded.ResultsThis study enrolled 8029 patients, including 1879 patients with ARDS. AKI occurred in 31.3% of patients and was more common in patients with ARDS (44.3% versus 27.4% in patients without ARDS; P<0.001). After adjustment for confounders, both mechanical ventilation without ARDS (odds ratio [OR], 4.34; 95% confidence interval [95% CI], 3.71 to 5.10) and ARDS (OR, 11.01; 95% CI, 6.83 to 17.73) were independently associated with AKI. Hospital mortality was 14.2% (n=1140) and was higher in patients with ARDS (27.9% versus 10.0% in patients without ARDS; P<0.001) and in patients with AKI (27.6% versus 8.1% in those without AKI; P<0.001). AKI was associated with higher mortality in patients with ARDS (42.3% versus 20.2%; P<0.001).ConclusionsARDS was independently associated with AKI. This study suggests that ARDS should be considered as a risk factor for AKI in critically ill patients.Copyright © 2014 by the American Society of Nephrology.

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