Outcome of Acute Kidney Injury with Different Treatment

Options: Long-Term Follow-up

An M. Van Berendoncks,* Monique M. Elseviers, and Robert L. Lins for the SHARF
Study Group
*Department of Medicine, University of Antwerp, Antwerp, Belgium; Nursing Sciences, University of Antwerp,
Antwerp, Belgium; and Nephrology-Hypertension, ZNA Stuivenberg, Antwerp, Belgium
Background and objectives: The multicenter Stuivenberg Hospital Acute Renal Failure 4 study investigated outcome in
patients with acute kidney injury (AKI) stratified according to disease severity by the Stuivenberg Hospital Acute Renal
Failure score. Patients in need of renal replacement therapy (RRT) received intermittent RRT or continuous RRT. This study
investigated long-term mortality, renal function, comorbidity, and quality of life.
Design, setting, participants, & measurements: All AKI hospital survivors were included. Mortality at 1 and 2 years of
follow-up was traced for all patients. Between 1 and 2 years after hospital discharge, survivors were visited at home to
determine morbidity (renal function), comorbidity (Charlson comorbidity index [CCI]), and quality of life (Medical Outcome
Survey SF-36).
Results: The baseline population consisted of 595 AKI patients. Mortality rates were 23.0 and 7.6%, respectively, during the
first and second year after discharge. Total mortality increased from 50.7% at discharge to 65.7% 2 years after AKI and was not
related to disease severity or treatment modality offered during hospitalization. Two hundred four survivors could be visited
at home. Mean serum creatinine did not differ between discharge and follow-up. CCI was only related with age. SF-36 scores
were negatively correlated with CCI, age, and body mass index, but not with disease severity, renal function, or dialysis
modality.
Conclusions: Long-term outcome of AKI consists of a high additional mortality unrelated to treatment modality offered
during hospitalization, varying evolution of renal recovery, and many comorbidities, but a mental health at the same level as
the general population.
Clin J Am Soc Nephrol 5: 17551762, 2010. doi: 10.2215/CJN.00770110

cute kidney injury (AKI) is common among critically

ill patients admitted to the intensive care unit (ICU),
up to 25% depending on the population studied (1-4).
Despite the advances in renal replacement therapy (RRT) and
supportive measures, the mortality rate remains very high,
with an in-hospital mortality rate of 50% and higher in particular populations (2,5,6). Although most studies use hospital
mortality as their major endpoint, little is known about the
long-term outcome after AKI. Previous studies investigating
long-term outcome of AKI had small sample sizes, were single
center retrospective studies, made no distinction in treatment
modality, or dealt with only few of the long-term outcome
aspects (7-12). In their meta-analysis reviewing 48 AKI outcome
studies, Coca et al. (13) made the important conclusion that
even mild AKI is associated with long-term adverse outcomes
and highlighted the need for further multicenter, prospective
trials.
Not only long-term survival, but also quality of life, renal

Received January 25, 2010. Accepted June 8, 2010.

Published online ahead of print. Publication date available at www.cjasn.org.
Correspondence: Dr. Robert Lins, MD, PhD, University of Antwerp, Hazelarenstraat 7, 2020 Antwerpen, Belgium. Phone: 32-3-2383310; Fax: 32-3-2162439; Email: robert.lins@scarlet.be
Copyright 2010 by the American Society of Nephrology

recovery, comorbidity, and costs of care have become important outcome parameters. Both in general intensive care
management and in specific treatment of AKI, it has been
recommended that these outcome measures should be incorporated in future research (14,15). Given the poor outcome of
AKI and the current trends in limitation of health care resources, questions arise about the allocation of resources to
this population. Investigating long-term outcome with quality of life and renal recovery are necessary to answer these
questions.
In previous Stuivenberg Hospital Acute Renal Failure
(SHARF) studies, a new scoring system for all patients with
AKI admitted to the ICU has been introduced. The SHARF
score for hospital mortality of patients with AKI was developed
in a single center study (16). In a second phase, the SHARF
score was tested in a multicenter study. After adaptation based
on multivariate analysis, the SHARF score was tested and
proved to be useful in different settings for comparing groups
of patients and centers (17).
This multicenter SHARF4 study investigated different
treatment options (conservative versus RRT) in patients with
AKI stratified according to severity of disease by SHARF
score. Patients in need for RRT (50%) were randomized to
intermittent (IRRT) or continuous RRT (CRRT) (18). The
ISSN: 1555-9041/510 1755

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Clinical Journal of the American Society of Nephrology

survivors of this study were used for the SHARF4 follow-up

to investigate long-term mortality, renal function, comorbidity, and quality of life.

Patients and Methods

SHARF4 Study
The multicenter prospective SHARF4 study included all adult patients consecutively admitted to the ICU of the participating centers
with AKI defined as a serum creatinine 2 mg/dl (177 M). Participating hospitals, patients, data collection, and RRT are described in
detail previously (18). In all included patients, disease severity was
defined by calculating the SHARF score (17) (see Appendix), and
patients were stratified in one of the SHARF severity classes accordingly (SHARF 30, 30 to 60, 60). The decision to treat conservatively
or to start RRT was at the discretion of the responsible physician, taking
into account the rules of good clinical practice in this field. Patients in
need for RRT were assigned to daily IRRT (intermittent hemodialysis
for 4 to 6 hours daily) or CRRT (continuous veno-venous hemofiltration).
Short-term outcome parameters studied were mortality, ICU and
hospital length of stay, and renal function at hospital discharge.

Follow-up Study
The study population of the SHARF4 study consisted of 1303 patients. Half of the patients died during their hospital stay. All patients
of the SHARF4 study who survived hospitalization and who were
admitted to one of the five participating hospitals that recruited patients until the end of the SHARF4 study were included in this follow-up study (n 595).
At 1 and 2 years after discharge, mortality was checked in the
National Registry.
After informed consent, a visit at home was performed by trained
medical students and study nurses. Weight and height were assessed, and
two questionnaires were completed. To determine comorbidity and quality of life, we used the Charlson Comorbidity index (CCI) (19) and the
Medical Outcome Survey Short-Form 36 (SF-36) (20).
The CCI consists of 19 comorbidities with a specific weight and
higher scores correlating with increased illness. We used the CCI to
score comorbid disease of each patient, excluding the additional
weighting for patient age.
The SF-36 is a generic measure of health status composed of 36
questions that are summarized with different weights in two overall
scales: the physical component summary (PCS) and the mental component summary (MCS) (20,21). The SF-36 PCS and MCS scores were
calculated using the published methods (21). These norm-based scoring
algorithms are based on a general U.S. population in 1998 and have a
mean of 50 10 (SD). A higher score indicates a better health-relating
quality of life (20,21).
Follow-up serum creatinine values were obtained from the general
practitioner or the participating hospitals. Renal function at hospital
discharge and at follow-up was investigated using the calculated
creatinine clearance according the Cockroft and Gault formula (22)
and corrected for body surface area. Stages of chronic kidney disease
were defined according the National Kidney Foundation Kidney
Disease Outcomes Quality Initiative (NKF K/DOQI) guidelines (23).

Clin J Am Soc Nephrol 5: 17551762, 2010

the dichotome variable mortality and the continuous variables SF-36

and CCI.
In the multivariate analysis, independent factors were added if they
showed significance in the univariate analysis. Binary logistic regression analysis was performed on mortality, and SF-36 and CCI were
analyzed by multiple regression. Survival 1 and 2 years after hospital
discharge was studied using the method of life table analysis with the
baseline assigned at hospital discharge. The significance level was set at
P 0.05.

Ethical Considerations
The protocol of the SHARF4 and this follow-up study has been
approved initially by the Ethics Committee of the Stuivenberg Hospital
in Antwerp and followed by the Ethics Committee of each participating
center. A written informed consent was received from each patient or
his representative in case the patient was unconscious or ventilated
during hospitalization.

Results
The baseline population studied consisted of 595 patients
that survived hospitalization after AKI (Figure 1). Patient characteristics at hospital discharge are given in Table 1. Mean age
of hospital survivors was 64.1 years (range, 16 to 97 years), and
63.9% were male.

Mortality
Mortality could be traced for all 595 patients at 1 and 2 years
after hospital discharge. One hundred thirty-seven of the 595
hospital survivors (23.0%) died within 1 year and 45 (7.6%) died
during the second year after discharge. Total mortality, including hospital mortality, increased from 50.7 to 65.7% 2 years
after AKI (Figure 2).
Characteristics of the long-term survivors at hospital discharge are described in Table 2. Comparing survivors at 2
years with nonsurvivors showed that the nonsurvivors were
older than the survivors (68.7 [range, 27 to 93 years] versus
60.9 years [range, 15 to 96 years]; P 0.001) and were

Statistical Analyses
Data were analyzed using the SPSS statistical package, version
12.0. Descriptive, univariate analysis was performed on all characteristics to investigate differences between mean and proportions
using Students t test and 2 test. Outcome variables studied were

Figure 1. Study population flow chart. Baseline population consisted of 595 hospital survivors. The investigated population
was composed of 204 patients that received a home visit.

Clin J Am Soc Nephrol 5: 17551762, 2010

Long-Term Follow-up of Acute Kidney Injury

1757

Table 1. Patient characteristics and clinical parameters at hospital discharge: description of hospital survivors and
comparison of the long-term survivors studied for morbidity, comorbidity, and quality of life with the rest of the
population

Patient characteristics
Age: mean (range)
Male sex (%)
BMI: mean (range)
Clinical characteristics
Ventilation (%)
Sepsis (%)
Setting of AKI (% medical)
Type of AKI (%)
Pre-renal
Renal
Post-renal
Acute on chronic disease
Specific renal causes of AKI (%)
Acute tubular necrosis
Acute glomerulonephritis
Acute interstitial nephritis
Systemic disease
Severity scores
SHARF score 0 h: mean (SD)
APACHE II 0 h: mean (SD)
SOFA 0 h: mean (SD)
SOFA 24 h: mean (SD)
SOFA 48 h: mean (SD)
Treatment (%)
Conservative
IRRT
CRRT
ICU and hospital stay
Days hospitalization: mean (range)
Late admission to ICU (%)
Renal outcome
Creatinine clearance at discharge
Mean (SD) ml/min
ESRD at discharge (%)

Hospital Survivors
(n 595)

Long-Term
Survivors Studied
(n 204)

Long-Term
Survivors Not
Studied (n 209)

P Value
of
Difference

64.1 (16 to 97)

63.9
26.3 (14.5 to 55.1)

61.1 (15 to 90)

58.9
26.3 (14.7 to 55.1)

60.8 (19 to 96)

64.1
26.8 (14.5 to 50.8)

0.848
0.278
0.387
0.600
0.287
0.068
0.026

47.4
40.0
71.5

49.0
41.5
74.0

46.4
36.4
65.7

49.7
42.4
0.8
7.0

44.8
46.8
0.0
8.4

53.4
42.7
1.0
2.9

84.4
5.9
4.7
3.9

86.3
6.3
4.2
3.2

87.5
5.7
4.5
2.3

51.1 (26.8)
21.0 (8.8)
7.8 (3.4)
7.3 (3.8)
6.9 (3.7)

50.2 (26.5)
22.0 (9.1)
7.8 (3.3)
7.2 (3.5)
7.0 (3.6)

57.1
28.4
14.5

52.5
33.3
14.2

0.981

42.8 (1 to 339)
42.8

41.8 (1 to 189)
37.3

61.0 (31.4)
13.1

50.4 (27.4)
20.5 (9.0)
7.9 (3.5)
7.6 (3.9)
6.8 (3.8)

0.942
0.111
0.728
0.306
0.667
0.037

63.6
22.5
13.9
41.9 (1 to 339)
44.7

0.976
0.132

59.5 (27.8)

66.0 (33.5)

0.064

13.2

10.5

0.395

To convert creatinine clearance in ml/min to ml/s, multiply by 0.01667. AKI, acute kidney injury; RRT, renal replacement
therapy; IRRT, intermittent renal replacement therapy; ICU, intensive care unit.

proportionally more male (70.2 versus 61.2%; P 0.036).

Survival analysis showed a 1-month survival of 92.6%, a
1-year survival of 76.7%, and a survival at 2 years of 69.2%
for the total group. Mean creatinine clearance at discharge
was significantly lower in the nonsurvivors versus survivors
(55.7 31.1 versus 63.0 31.3 ml/min; P 0.030; expressed
in SI units 0.93 0.52 versus 1.05 0.52 ml/s). Binary logistic
regression analysis detected only age and gender as independent predictors of long-term mortality.
As shown in Table 2, the disease severity observed during
hospitalization (SHARF, Acute Physiology and Chronic Health

Evaluation [APACHE II], Sequential Organ Failure Assessment

[SOFA]) was not related to the 2-year mortality. Additionally,
the length of stay in the ICU and hospital, late ICU admission,
type of AKI, and cause of AKI did not show significant differences between survivors and nonsurvivors.
No difference in 2-year survival was observed in treatment
modality (conservative treatment, IRRT, CRRT) offered during
hospital stay (Figure 3). Additional correction for disease severity using the SHARF, APACHE II, and SOFA scores did not
change this result. Moreover, separate survival analysis comparing the conservative treated AKI with the total group of RRT

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Clinical Journal of the American Society of Nephrology

Figure 2. Mortality in AKI patients admitted to the intensive

care unit. Mortality could be traced for all patients at 1 and 2
years after discharge. Delayed mortality mortality during the
first/second year after release.

and a subanalysis comparing the two types of RRT did not

show a significant difference in long-term outcome according
to treatment modality.(all P 0.05)

Morbidity, Comorbidity, and Quality of Life

Of the 595 hospital survivors, 182 patients died before contacted. From the 413 long-term survivors considered for further
study, 142 patients were lost to follow-up (mostly no contact
and/or no appointment possible) and 67 patients did not consent (Figure 1). Two hundred four patients were studied with
home visit at a mean of 20.3 7.3 (SD) months after hospital
discharge. The baseline data of the long-term survivors with
and without home visit only differed regarding the type of AKI
and treatment modality (Table 1).
Serum creatinine values were compared between discharge
and follow-up in 153 of the 204 patients. Mean serum creatinine
of this population was 1.4 0.7 mg/dl (124 62 M) at
discharge and 1.4 0.6 mg/dl (124 53 M) after 1 year (P
0.717). Creatinine clearance at discharge (61.1 27.5 ml/min;
1.02 0.46 ml/s) did not differ significantly from follow-up
(61.9 28.4 ml/min; 1.03 0.47 ml/s; P 0.663).
According to the NKF K/DOQI classification of renal failure,
one half of the patients stayed in the same category, one quarter
decreased, and one quarter increased. Figure 4 shows for the
total population that, within each class, there is an evolution
toward a larger spread in both a positive and negative direction. At hospital discharge, 27 patients were diagnosed with
ESRD. During the follow-up period, 13 patients became dialysis-independent, whereas 7 patients needed chronic dialysis
treatment.
CCI at follow-up showed a median of 2 (range, 0 to 15).
Peripheral vascular disease (24.5%), peptic ulcer disease
(21.6%), diabetes (19.1%), and myocardial infarction (16.7%)
were the most common comorbidities. CCI did not show any

Clin J Am Soc Nephrol 5: 17551762, 2010

significant relationship with clinical parameters noted during

hospitalization (different scores for severity of disease, renal
function, treatment modalities, sepsis, ventilation, body mass
index, late admission to the ICU, and length of stay in the
hospital), except for age (r 0.165, P 0.05).
The SF-36 was completed in all 204 patients by self-administration or with the assistance of a trained interviewer in case
of difficulties with reading. The mean PCS was 42.1 12.8 and
the mean MCS had a value of 51.0 11.6. PCS and MCS were
negatively correlated with CCI (r 0.401, P 0.01 and r
0.149, P 0.05, respectively). Of all of the clinical parameters
during hospitalization, only age and body mass index correlated with health-related quality of life. Age showed a significant negative correlation of 0.282 with PCS (P 0.01) and a
significant positive correlation of 0.174 with MCS (P 0.05).
Body mass index was negatively correlated with PCS (r
0.223, P 0.01). Figure 5 represents the distribution of the
scores by different age groups and shows that the PCS declines
with age and the MCS generally remains stable or even increases with age.
The SF-36 summary scores did not show any significant
relationship with the different scores for severity of disease,
renal function, treatment modalities, and length of stay in the
hospital. Binary logistic regression analysis for comparison of
PCS values 35 and 35 was applied to identify factors associated with poor health-related quality of life. Body mass index
and age categories seemed to be significantly related (P 0.032
and P 0.047, respectively), indicating a lower physically
health-related quality of life with higher body mass index and
older age.

Discussion
Several interesting findings emerged from this multicenter
prospective follow-up study.
Through a complete reporting of 1- and 2-year survival, we
found comparable outcomes for intermittent and continuous
RRT. Moreover, the inclusion of a large number of conservative
treated patients allowed the observation that 2-year mortality is
comparable between the conservatively treated group versus
those patients treated with RRT. Apart from mortality, we
assessed renal function after hospital discharge as advised in a
recent review of RRT in AKI patients (24). Furthermore, our
long-term follow-up study included survival, morbidity, and
quality of life.

Mortality
Our results confirmed the poor prognosis of AKI with a
hospital mortality rate of 50.7% in the original cohort and a
high additional mortality rate of 11.3 and 3.4%, respectively,
during the first and second year after hospital discharge. The
same observation was made in a 1-year follow-up of the previous SHARF II study that investigated mortality and renal
function after hospitalization for AKI with a hospital mortality
rate of 51% and an additional mortality rate during the first
year of 11% (25). Comparison with published data of other
long-term follow-up studies of AKI is difficult because they
differ in the populations studied and length of observation

Clin J Am Soc Nephrol 5: 17551762, 2010

Long-Term Follow-up of Acute Kidney Injury

1759

Table 2. Baseline characteristics of long-term survivors and nonsurvivors

Patient characteristics
Age: mean (range)
Male sex (%)
BMI: mean (SD)
Severity scores
SHARF score 0 h: mean (SD)
APACHE II 0 h: mean (SD)
SOFA 0 h: mean (SD)
Treatment (%)
Conservative
IRRT
CRRT
ICU and hospital stay
Days ICU: mean (range)
Days hospitalization: mean (range)
Renal outcome
Creatinine clearance at discharge: mean
(SD) ml/min
NKF K/DOQI categories at discharge: (%)
60 ml/min
30 to 60 ml/min
30 ml/min
ESRD at discharge (%)

Survivors
(n 413)

Nonsurvivors
(n 182)

P Value of
Difference

60.9 (15 to 96)

61.2
26.5 (5.6)

68.7 (27 to 93)

70.2
25.9 (4.3)

0.001
0.036
0.253

50.8 (26.7)
21.1 (9.1)
7.8 (3.4)

51.9 (27.2)
20.8 (8.1)
7.6 (3.5)

57.1
28.6
14.3

57.1
28.0
14.8

13.4 (1 to 106)
41.5 (1 to 339)

13.6 (1 to 88)
45.6 (1 to 272)

0.909
0.285

63.0 (31.3)

55.7 (31.1)

0.030a

0.658
0.779
0.414
0.980

0.049a
41.5
34.7
23.8
11.9

32.0
34.7
33.3
15.9

0.175

RRT, renal replacement therapy; IRRT, intermittent renal replacement therapy; ICU, intensive care unit.
a
Binary logistic regression detected only age and gender as independent predictors of long-term mortality.

period. hlstrom et al. (26) reported both a 1- and 5-year high

mortality rate of 60 and 70%. Korkeila et al. (7) observed a
mortality of 55% at 6 months that rose to 65% at 5 years. Gopal
et al. (8) and Morgera et al. (11) reported both a higher hospital
mortality and mortality at follow-up. Both of these studies,
however, included only patients treated with CRRT, possibly
indicating more severe illness.
Comorbid conditions during hospitalization for AKI, such
as sepsis, ventilation, late ICU admission, and other characteristics of severity of disease expressed by different scoring
systems, have an important impact on survival in the ICU
and hospital (5,7,27,28). In contrast, these parameters were
not predictive for long-term prognosis in this cohort study.
Also, the SHARF score was not predictive for long-term
prognosis.
The most important decline in survival occurred during the
first month (7.4%). It might be that patients are discharged from
the hospital too soon or that there is a lack of follow-up immediately after discharge. Possibly, preventive measures should
aim at follow-up during the first year after discharge with
special attention to the first month.
Although it has been shown by us (18) and others (15,24) that
the method of RRT has no influence on short-term outcome, we
can confirm that, in this multicenter, prospective trial, there is
also no difference in the treatment modalities regarding longterm outcome of AKI.

Renal Function
In this study, we observed a wide variation in the evolution
of renal function after discharge. During the follow-up period,
13 patients (of 27 with ESRD at discharge) became dialysis
independent and 7 additional patients developed ESRD. Of the
population that was visited at home, 10.3% was in need of
chronic RRT. This result is in line with observations made by
other groups. In the study of Bhandari et al. (29), 16% of the
AKI survivors were dialysis dependent at discharge, with only
a small portion recovering at 18 months after AKI. Morgera et
al. (11) reported that 10% of their patients required RRT between 6 months and 5 years after discharge.

Comorbidity
Comorbidity of patients in this study has been assessed by
the CCI, which has been proven to be efficient to predict
survival in several ESRD populations (30-32). We found a median CCI score of 2 (0 to 15), which is comparable with the
findings in other AKI follow-up studies (9,10). Because we
assessed the CCI at follow-up and not at hospital discharge, we
could not use the CCI to predict long-term survival. However,
determination of comorbidity stayed important in evaluating
other outcome parameters. As reported by van Manen et al.
(33), CCI adjusts for the potential confounding effect of comorbidity in evaluation studies with health status as an outcome.

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Clinical Journal of the American Society of Nephrology

Figure 3. Two-year survival according to treatment option. A

general comparison showed no difference in long-term survival
according to different treatment options.
As expected, CCI showed a negative correlation with SF-36
scores (both PCS and MCS).

Quality of Life
The SF-36 has been validated both in the ICU (34,35) and in
chronic hemodialysis (36) populations.

Clin J Am Soc Nephrol 5: 17551762, 2010

Figure 5. Medical Outcome Survey Short-Form 36 mean physical component summary and mental component summary
scores by age groups. The scores were normed based on the
general U.S. population with a standard mean of 50 10 (SD).

We found in relation to age that PCS declined and MCS

remained stable in comparison with the U.S. population. Moreover, we confirmed the lower PCS of our AKI population by
comparing our results with the general population values of
our neighbor countries (37).
The mean MCS was comparable to the general population
values. The decline of PCS with age and the MCS remaining
stable or even increasing (Figure 5) have also been described in
general population samples of nine Western countries (37),
which explains that the decline is a normal trend in general
populations, although in our study population, the decrease of
PCS was more pronounced.
Apart from age, other parameters such as severity of disease
and clinical parameters during hospitalization did not show
any significant relationship with the SF-36 summary scores.
Therefore, this observation confirmed the statement of Maynard et al. (10) that health-related quality of life is difficult to
predict from data available at the time of acute illness in AKI
patients.

Limitations

Figure 4. Creatinine clearance at baseline and follow-up according to NKF K/DOQI categories at baseline. The spread within
each category increases toward follow-up, both in the positive
and in the negative direction.

The most important limitation of our study is the limited

number of subjects that could be studied at home for morbidity,
comorbidity, and quality of life. This study might have overestimated the health-related quality of life and underestimated
the burden of comorbidities because reasons such as illness,
hospital admission, avoiding confrontation with their disease,
and dementia played a major role in the consent process. However, this selection bias concerned CCI and SF-36 as outcome
parameters but not mortality, which could be checked in all of
the hospital survivors at 1 and 2 years after discharge. Despite

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Long-Term Follow-up of Acute Kidney Injury

its limitations, this study adds to our knowledge, because all

data are derived from a multicenter prospective study, and
represents the largest cohort with investigation of the long-term
outcome of AKI with mortality, renal function, comorbidity,
and health-related quality of life. A second limitation in our
study concerns the lack of data of health-related quality of life
and comorbidity before admission or at discharge. Therefore,
individual evolution or predictive value of both the SF-36 and
the CCI could not be assessed. Next, we did not investigate the
causes of death during follow-up or their relationship with
AKI. Finally, because this is the first multicenter prospective
trial investigating the long-term outcome of AKI comparing
treatment modalities, our results need to be confirmed in larger
trials.

Conclusion
In conclusion, the long-term survival of patients with AKI
admitted to the ICU is poor.
This mortality rate is not related to disease severity or treatment modality offered during hospitalization. Comparison of
renal function between discharge and follow-up shows no
change during follow-up. A considerable part of the hospital
survivors stayed in need of chronic RRT and had important
comorbidities. The physical component health-related quality
of life of the SF-36 score in the survivors was lower compared
with age-matched general populations, whereas the mental
health-related quality of life was found to be the same as in the
general population.

SHARF SCORE
SHARF0 = 3*age
+ 2.6*albT0
+ 1.3*PTTT0
+ 16.8*ventT0
+ 3.9*heartfT0
+ 2.8*biliT0
+ 27*sepsT0
+ 21*hypoT0
- 17

Parameters

age:
decade (ex. 10-19y= 1; 20-29y= 2)

vent:
respiratory support: no = 0; yes = 1
heartf:
heart failure:
no = 0; yes = 1

seps:
sepsis:

hypo: hypotension
< 90 mmHg:
no = 0; yes = 1
bili: bilirubin, mg/dl
(continuous variable)

no = 0; yes = 1

alb :
albumin,
g/L
>45 = 1
41-45 = 2
36-40 = 3
31-35 = 4
26-30 = 5
21-25 = 6
< 21 = 7

PTT:
prothrombine
time, %
>80 = 1
66-80 = 2
56-65 = 3
46-55 = 4
36-45 = 5
26-35 = 6
16-25 = 7
< 15 = 8

Appendix. SHARF score.

Acknowledgments
This work was supported by the nephrological research resources of
AZ Stuivenberg Hospital. The members of the SHARF study group
were as followsCoordinating Center: R. L. Lins, M. M. Elseviers, S.
Van Bastelaere, and A. Van Berendoncks; Steering Committee: P.
Damas, J. Devriendt, M. M. Elseviers, E. Hoste, R. L. Lins, M. Malbrain,
and P. Van der Niepen; Data Collection: T. De Keyser, J. W. De Neve,
V. Lins, T. Mellaerts, S. Van Bastelaere, and A. Van Berendoncks; Data
Analysis and Statistics: M. M. Elseviers and A. Van Berendoncks;
Participating Centers: University Hospital Vrije Universiteit Brussel, P.
Van der Niepen, D. Verbeelen, I. Hubloue; ZNA Stuivenberg Hospital,
R. Daelemans, M. Malbrain, J. Leys, R. L. Lins; University Hospital
Gent, E. Hoste, R. Lameire, W. Van Biesen; University Hospital Lie`ge,
P. Damas, B. Dubois, J. M. Krzesinski; Brugmann University Hospital,
Brussel, J. Devriendt, M. Dratwa, R. Wens.

1761

Disclosures
None.

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