Clinical features and outcome of chronic dialysis patients admitted to an intensive care unit

Manhes, Géraud; Heng, Anne Elisabeth; Aublet-Cuvelier, Bruno; Gazuy, N; Deteix, P; Souweine, Bertrand

doi:10.1093/ndt/gfh762

Cited by 53 publications

(59 citation statements)

References 21 publications

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“…Adjustment for these factors (Table 3) largely eliminated the association between ESRD status and death. Overall, our observations on mortality are congruent with those of previous studies examining the effect of ESRD in a more general ICU population (5)(6)(7)(8)(9)(10)(11)(12). These studies reported crude ICU mortality rates for ESRD ranging from 14% to 52.6%, bracketing our estimate of 22%.…”

Section: Discussionsupporting

confidence: 90%

“…From a clinical perspective, accurate estimates of prognosis would help to inform care and management of critically ill elderly dialysis patients. Several small and two large studies have described outcomes of ESRD patients admitted to the ICU (5)(6)(7)(8)(9)(10)(11)(12). ESRD status was associated with an approximately twofold higher mortality, but this effect was largely attributable to case mix and illness severity variables.…”

Section: Introductionmentioning

confidence: 99%

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End-Stage Renal Disease Status and Critical Illness in the Elderly

Sood

Roberts

Komenda

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Elderly patients (Ͼ65 years old) are a rapidly growing demographic in the ESRD and intensive care unit (ICU) populations, yet the effect of ESRD status on critical illness in elderly patients remains unknown. Reliable estimates of prognosis would help to inform care and management of this frail and vulnerable population. Design, setting, participants, & measurementsThe effect of ESRD status on survival and readmission rates was examined in a retrospective cohort of 14,650 elderly patients (Ͼ65 years old) admitted to 11 ICUs in Winnipeg, Manitoba, Canada between 2000 and 2006. Logistic regression models were used to adjust odds of mortality and readmission to ICU for baseline case mix and illness severity.Results Elderly ESRD patients had twofold higher crude in-hospital mortality (22% versus 13%, P Ͻ 0.0001) and readmission rate (6.4 versus 2.7%, P ϭ 0.001). After adjustment for illness severity alone or illness severity and case mix, the odds ratio for mortality decreased to 0.85 (95% CI: 0.57 to 1.25) and 0.82 (95% CI: 0.55 to 1.23), respectively. In contrast, ESRD status remained significantly associated with readmission to ICU after adjustment for other risk factors (OR 2.06 [95% CI: 1.32, 3.22 ]).Conclusions Illness severity on admission, rather than ESRD status per se, appears to be the main driver of in-hospital mortality in elderly patients. However, ESRD status is an independent risk factor for early and late readmission, suggesting that this population might benefit from alternative strategies for ICU discharge.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

End-Stage Renal Disease Status and Critical Illness in the Elderly

Sood

Roberts

Komenda

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…In-hospital mortality in their study was lower than in our study (34% in patients with AKI, 14% in patients with ESRD, and 9% in control subjects). Manhes et al 8 studied at 92 longterm dialysis patients who were admitted to the ICU and found mortality rates in hospital of 38%, with mean ICU LOS 6.2 Ϯ 9.9 d. Dara et al 9 examined mortality of 93 patients who had ESRD and were admitted to the ICU and found ICU, hospital, and 30-d mortality rates to be 9, 16, and 22%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…4 -6 Unfortunately, corresponding data on patients who have ESRD and are admitted to the ICU in North American centers are sparse, [7][8][9] and in toto these studies report on only 239 patients with ESRD. Only one study 7 compared in-hospital mortality in patients with ESRD (n ϭ 57), patients without ESRD (n ϭ 1219), and patients with AKI (n ϭ 254), reporting rates of 14, 9, and 34%, respectively.…”

mentioning

confidence: 99%

Outcomes of Chronic Dialysis Patients Admitted to the Intensive Care Unit

Strijack

Mojica²,

Sood³

et al. 2009

Journal of the American Society of Nephrology

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Admission rates and outcomes of patients who have ESRD and are admitted to an intensive care unit (ICU) are not well defined. We conducted a historical cohort study using a prospective regional ICU database that captured all 11 adult ICUs in Winnipeg, Canada. Between 2000 and 2006, there were 34,965 total admissions to the ICU, 1173 (3.4%) of which were patients with ESRD. The main admission diagnoses among patients with ESRD were cardiac disease (31%), sepsis (15%), and arrest (10%). Compared with other patients in the ICU, those with ESRD were significantly younger but had more diabetes, peripheral arterial disease, and higher APACHE II (Acute Physiology and Chronic Health Evaluation II) scores; mean length of stay in the ICU was similar, however, between these two groups. Restricting the analysis to first admissions to the ICU, unadjusted in-hospital mortality was higher for patients with ESRD (16 versus 11%; P Ͻ 0.0001), but this difference did not persist after adjustment for baseline illness severity. In conclusion, although ESRD associates with increased mortality among patients who are admitted to the ICU, this effect is mostly a result of comorbidity.

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“…[7][8][9][10][11] The majority of past studies were small, single-center analyses with limited inference to generalize. The only previous analysis of a large regional data set used the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database from Great Britain.…”

mentioning

confidence: 99%