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Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study

INTRODUCTION: Continuous renal replacement therapy (CRRT) is a widely used but resource-intensive treatment. Despite its broad adoption in intensive care units (ICUs), it remains challenging to identify patients who would be most likely to achieve positive outcomes with this therapy and to provide r...

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Autores principales: Allegretti, Andrew S, Steele, David JR, David-Kasdan, Jo Ann, Bajwa, Ednan, Niles, John L, Bhan, Ishir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057378/
https://www.ncbi.nlm.nih.gov/pubmed/23782899
http://dx.doi.org/10.1186/cc12780
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author Allegretti, Andrew S
Steele, David JR
David-Kasdan, Jo Ann
Bajwa, Ednan
Niles, John L
Bhan, Ishir
author_facet Allegretti, Andrew S
Steele, David JR
David-Kasdan, Jo Ann
Bajwa, Ednan
Niles, John L
Bhan, Ishir
author_sort Allegretti, Andrew S
collection PubMed
description INTRODUCTION: Continuous renal replacement therapy (CRRT) is a widely used but resource-intensive treatment. Despite its broad adoption in intensive care units (ICUs), it remains challenging to identify patients who would be most likely to achieve positive outcomes with this therapy and to provide realistic prognostic information to patients and families. METHODS: We analyzed a prospective cohort of all 863 ICU patients initiated on CRRT at an academic medical center from 2008 to 2011 with either new-onset acute kidney injury (AKI) or pre-admission end-stage renal disease (ESRD). We examined in-hospital and post-discharge mortality (for all patients), as well as renal recovery (for AKI patients). We identified prognostic factors for both in-hospital and post-discharge mortality separately in patients with AKI or ESRD. RESULTS: In-hospital mortality was 61% for AKI and 54% for ESRD. In patients with AKI (n = 725), independent risk factors for mortality included age over 60 (OR 1.9, 95% CI 1.3, 2.7), serum lactate over 4 mmol/L (OR 2.2, 95% CI 1.5, 3.1), serum creatinine over 3 mg/dL at time of CRRT initiation (OR 0.63, 95% CI 0.43, 0.92) and comorbid liver disease (OR 1.75, 95% CI 1.1, 2.9). Among patients with ESRD (n = 138), liver disease was associated with increased mortality (OR 3.4, 95% CI 1.1, 11.1) as was admission to a medical (vs surgical) ICU (OR 2.2, 95% CI 1.1, 4.7). Following discharge, advanced age became a predictor of mortality in both groups (AKI: HR 1.9, 95% CI 1.2, 3.0; ESRD: HR 4.1, 95% CI 1.5, 10.9). At the end of the study period, only 25% (n = 183) of patients with AKI achieved dialysis-free survival. CONCLUSIONS: Among patients initiating CRRT, risk factors for mortality differ between patients with underlying ESRD or newly acquired AKI. Long-term dialysis-free survival in AKI is low. Providers should consider these factors when assessing prognosis or appropriateness of CRRT.
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spelling pubmed-40573782014-06-14 Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study Allegretti, Andrew S Steele, David JR David-Kasdan, Jo Ann Bajwa, Ednan Niles, John L Bhan, Ishir Crit Care Research INTRODUCTION: Continuous renal replacement therapy (CRRT) is a widely used but resource-intensive treatment. Despite its broad adoption in intensive care units (ICUs), it remains challenging to identify patients who would be most likely to achieve positive outcomes with this therapy and to provide realistic prognostic information to patients and families. METHODS: We analyzed a prospective cohort of all 863 ICU patients initiated on CRRT at an academic medical center from 2008 to 2011 with either new-onset acute kidney injury (AKI) or pre-admission end-stage renal disease (ESRD). We examined in-hospital and post-discharge mortality (for all patients), as well as renal recovery (for AKI patients). We identified prognostic factors for both in-hospital and post-discharge mortality separately in patients with AKI or ESRD. RESULTS: In-hospital mortality was 61% for AKI and 54% for ESRD. In patients with AKI (n = 725), independent risk factors for mortality included age over 60 (OR 1.9, 95% CI 1.3, 2.7), serum lactate over 4 mmol/L (OR 2.2, 95% CI 1.5, 3.1), serum creatinine over 3 mg/dL at time of CRRT initiation (OR 0.63, 95% CI 0.43, 0.92) and comorbid liver disease (OR 1.75, 95% CI 1.1, 2.9). Among patients with ESRD (n = 138), liver disease was associated with increased mortality (OR 3.4, 95% CI 1.1, 11.1) as was admission to a medical (vs surgical) ICU (OR 2.2, 95% CI 1.1, 4.7). Following discharge, advanced age became a predictor of mortality in both groups (AKI: HR 1.9, 95% CI 1.2, 3.0; ESRD: HR 4.1, 95% CI 1.5, 10.9). At the end of the study period, only 25% (n = 183) of patients with AKI achieved dialysis-free survival. CONCLUSIONS: Among patients initiating CRRT, risk factors for mortality differ between patients with underlying ESRD or newly acquired AKI. Long-term dialysis-free survival in AKI is low. Providers should consider these factors when assessing prognosis or appropriateness of CRRT. BioMed Central 2013 2013-06-20 /pmc/articles/PMC4057378/ /pubmed/23782899 http://dx.doi.org/10.1186/cc12780 Text en Copyright © 2013 Allegretti et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Allegretti, Andrew S
Steele, David JR
David-Kasdan, Jo Ann
Bajwa, Ednan
Niles, John L
Bhan, Ishir
Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study
title Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study
title_full Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study
title_fullStr Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study
title_full_unstemmed Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study
title_short Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study
title_sort continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057378/
https://www.ncbi.nlm.nih.gov/pubmed/23782899
http://dx.doi.org/10.1186/cc12780
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