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Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study

BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) who develop acute kidney injury have increased mortality and frequently require renal replacement therapy (RRT). The optimal timing for initiation of RRT after onset of ARDS to improve survival is not known. METHODS: We retrospecti...

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Autores principales: Dill, Joshua, Bixby, Billie, Ateeli, Huthayfa, Sarsah, Benjamin, Goel, Khushboo, Buckley, Ryan, Finkelshteyn, Ilya, Thajudeen, Bijin, Kadambi, Pradeep V, Bime, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163023/
https://www.ncbi.nlm.nih.gov/pubmed/30288081
http://dx.doi.org/10.2147/IJNRD.S164628
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author Dill, Joshua
Bixby, Billie
Ateeli, Huthayfa
Sarsah, Benjamin
Goel, Khushboo
Buckley, Ryan
Finkelshteyn, Ilya
Thajudeen, Bijin
Kadambi, Pradeep V
Bime, Christian
author_facet Dill, Joshua
Bixby, Billie
Ateeli, Huthayfa
Sarsah, Benjamin
Goel, Khushboo
Buckley, Ryan
Finkelshteyn, Ilya
Thajudeen, Bijin
Kadambi, Pradeep V
Bime, Christian
author_sort Dill, Joshua
collection PubMed
description BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) who develop acute kidney injury have increased mortality and frequently require renal replacement therapy (RRT). The optimal timing for initiation of RRT after onset of ARDS to improve survival is not known. METHODS: We retrospectively reviewed clinical data on patients admitted to our health system over a 2-year period. Individual charts were carefully reviewed to ascertain that patients met the Berlin criteria for ARDS and to categorize RRT utilization. The Kaplan–Meier analysis was conducted to compare early (£48 hours postintubation) versus late (>48 hours postintubation) initiation of RRT. Associations between RRT initiation and mortality were evaluated using Cox proportional hazards regression. RESULTS: A total of 75 patients were identified with ARDS, 95% of whom received RRT. Mortality of patients who required RRT was 56%. The main indications for RRT initiation were fluid overload (75%), metabolic acidosis (64%), and hyperkalemia (33%). The Kaplan–Meier analysis comparing early initiation of RRT to late initiation of RRT showed no survival benefit. Cox proportional hazard models testing the association between timing of RRT initiation with survival and adjusting for sex, race, ethnicity, and Acute Physiology and Chronic Health Evaluation II score did not reach statistical significance (HR=0.94, 95% CI=0.48–1.86). CONCLUSION: Timing of RRT initiation was not associated with a survival benefit. Prospective study in the utilization and outcomes of RRT in ARDS could assist in optimizing its usage in this population.
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spelling pubmed-61630232018-10-04 Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study Dill, Joshua Bixby, Billie Ateeli, Huthayfa Sarsah, Benjamin Goel, Khushboo Buckley, Ryan Finkelshteyn, Ilya Thajudeen, Bijin Kadambi, Pradeep V Bime, Christian Int J Nephrol Renovasc Dis Original Research BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) who develop acute kidney injury have increased mortality and frequently require renal replacement therapy (RRT). The optimal timing for initiation of RRT after onset of ARDS to improve survival is not known. METHODS: We retrospectively reviewed clinical data on patients admitted to our health system over a 2-year period. Individual charts were carefully reviewed to ascertain that patients met the Berlin criteria for ARDS and to categorize RRT utilization. The Kaplan–Meier analysis was conducted to compare early (£48 hours postintubation) versus late (>48 hours postintubation) initiation of RRT. Associations between RRT initiation and mortality were evaluated using Cox proportional hazards regression. RESULTS: A total of 75 patients were identified with ARDS, 95% of whom received RRT. Mortality of patients who required RRT was 56%. The main indications for RRT initiation were fluid overload (75%), metabolic acidosis (64%), and hyperkalemia (33%). The Kaplan–Meier analysis comparing early initiation of RRT to late initiation of RRT showed no survival benefit. Cox proportional hazard models testing the association between timing of RRT initiation with survival and adjusting for sex, race, ethnicity, and Acute Physiology and Chronic Health Evaluation II score did not reach statistical significance (HR=0.94, 95% CI=0.48–1.86). CONCLUSION: Timing of RRT initiation was not associated with a survival benefit. Prospective study in the utilization and outcomes of RRT in ARDS could assist in optimizing its usage in this population. Dove Medical Press 2018-09-26 /pmc/articles/PMC6163023/ /pubmed/30288081 http://dx.doi.org/10.2147/IJNRD.S164628 Text en © 2018 Dill et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Dill, Joshua
Bixby, Billie
Ateeli, Huthayfa
Sarsah, Benjamin
Goel, Khushboo
Buckley, Ryan
Finkelshteyn, Ilya
Thajudeen, Bijin
Kadambi, Pradeep V
Bime, Christian
Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study
title Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study
title_full Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study
title_fullStr Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study
title_full_unstemmed Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study
title_short Renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study
title_sort renal replacement therapy in patients with acute respiratory distress syndrome: a single-center retrospective study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163023/
https://www.ncbi.nlm.nih.gov/pubmed/30288081
http://dx.doi.org/10.2147/IJNRD.S164628
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