Early Mortality on Continuous Renal Replacement Therapy (CRRT): The Prairie CRRT Study

Abstract

BackgroundPatients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have an increased short-term and long-term risk of mortality. In most North American intensive care units (ICUs), these patients receive continuous renal replacement therapy (CRRT).ObjectiveWe aim to identify clinical and demographic factors associated with mortality within 24 h of initiating CRRT.DesignThis paper is a prospective cohort study.SettingThe setting involves three ICUs (12-bed surgical ICU, 10-bed medical ICU, and a 7-bed combined ICU for both medical and surgical patients) of the Regina Qu’Appelle Health Region (RQHR) Saskatchewan, Canada.PatientsThe patients were 106 individuals with AKI who were admitted to the ICUs and received CRRT from April 2013 to September 2014.MeasurementsDate and time of admission, transfer to, and initiation of CRRT were documented. Demographic data, use of vasoactive medications, ventilator settings, pH, urine output, and chronic disease comorbidities were measured.MethodsThe methods involved a stepwise multiple variable logistic regression model using death within 24 h of starting CRRT as the dependent variable, with significant variables derived from univariate analysis as covariates.ResultsOf the 2634 patients admitted to the ICUs in the study period (April 2013 to September 2014), 83.6 % (2201/2634) had no AKI. Two hundred and sixty-nine or 10.2 % of the patients had stage 3 AKI. One hundred six of the 269 patients (40%) were started on CRRT. Of those on CRRT, 66/106 died in the ICU while on CRRT. Seventeen of the 66 patients (26%) died within 24 h of initiating therapy. In univariate logistic regression models, factors associated with early mortality included fraction of inspired oxygen (per 0.1 unit) (OR 1.39, 95 % CI 1.09–1.77); epinephrine dose >10 μg/min (OR 5.81, 95 % CI 1.86–18.16); vasopressin >0.02 μg/min (OR 3.99, 95 % CI 1.07–14.84); and norepinephrine dose >20 μg/min (OR 11.04, 95 % CI 2.38–51.24) which were associated with early mortality. When included in stepwise multivariate logistic regression analysis, only FiO2 (per 0.1 unit) and the dose of norepinephrine of >20 μg/min were independently associated with early mortality.LimitationsThe small sample size was a limitation of this study.ConclusionPatients admitted to the ICU with AKI requiring CRRT have a high risk of early mortality. In these patients, vasopressor use and hypoxia were independently associated with adverse short-term survival.

Analysis of Survival After Initiation of Continuous Renal Replacement Therapy in a Surgical Intensive Care Unit

“…Although this mortality rate does not consider the number of patients excluded from mortality analysis (23 of 108) owing to liver transplant, it is near the range reported in large studies in the literature that have generally not included patients awaiting liver transplant. 9,[16][17][18] Few studies include patients in an SICU, and when included, these patients are rarely treated as a separate population. A notable exception is a study conducted by the National Taiwan University Surgical ICU Associated Renal Failure Study Group (NSARF) from 2002 to 2006, 19 which found a 40% rate of survival at 90 days after initiation of CRRT among 137 patients undergoing surgery.…”

Machine learning algorithm to predict mortality in patients undergoing continuous renal replacement therapy

“…However, these models did not focus on patients initiating CRRT for AKI. A few studies have identified risk factors of mortality in patients receiving CRRT [29,30]. Nevertheless, it is necessary to develop a mortality prediction model because a few clinical variables may not be sufficient to precisely predict patient outcome.…”

CRRT in patients with HIV/AIDS

“…Meanwhile it resulted in lung injury and gas exchange by inducing pulmonary inflammatory response. Tumor necrosis factorα and other immunomodulatory molecules were released as a response to the reaction of the infection [24,25].Prasad et al found that patients with a higher FiO2 requirements while ventilated and a higher vasoactive agent requirement were inclined to have an early(24 h) mortality [26]. PCP prophylaxis has been widely used in developed country [23], but still unpopularly used in developing country.…”