End-stage renal disease and outcome in a surgical intensive care unit

Abstract

IntroductionEnd-stage renal disease (ESRD) is associated with an increased propensity for critical illness, but whether ESRD is independently associated with a greater risk of death after major surgical procedures is unclear.MethodsThis was a retrospective analysis of prospectively collected data from all adult (>18 years) patients admitted to a 50-bed surgical intensive care unit (ICU) between January 2004 and January 2009. ESRD was defined as the need for chronic peritoneal dialysis or hemodialysis for at least 6 weeks prior to ICU admission. We used multivariable logistic regression analysis and propensity-score matching to adjust for possible confounders.ResultsIn total, 12,938 adult patients were admitted during the study period; 199 patients had ESRD at ICU admission, giving a prevalence of 1.5%. Patients with ESRD were more likely to be male (72.9% versus 63.0%, P = 0.004) and had higher severity scores, a higher incidence of diabetes mellitus and cirrhosis, and a lower incidence of cancer at ICU admission than those without ESRD. Patients with ESRD were more likely to have any type of organ failure at ICU admission and during the ICU stay. Patients with ESRD had higher ICU and hospital mortality rates (23.1% and 31.2% versus 5.5% and 10.0%, respectively, P <0.001 pairwise) and longer ICU length of stay (2 (1 to 7) versus 1 (1 to 3) days, P <0.001). In multivariable logistic regression analysis, ESRD was independently associated with a greater risk of in-hospital death (odds ratio = 3.84, 95% confidence interval 2.68 to 5.5, P <0.001). In 199 pairs of patients, hematologic and hepatic failures were more prevalent, ICU and hospital mortality rates were higher (23.1% versus 15.1% and 31.2% versus 19.1%, P <0.05 pairwise), and ICU length of stay was longer (2 (1 to 7) versus 1 (1 to 7) days, P <0.001) in patients with ESRD.ConclusionsIn this large cohort of surgical ICU patients, presence of ESRD at ICU admission was associated with greater morbidity and mortality and independently associated with a greater risk of in-hospital death. Our data can be useful in preoperative risk stratification.

Resource use and outcomes in patients with dialysis‐dependent chronic kidney disease admitted to intensive care

“…The lack of a mortality signal is in stark contrast to other studies . The largest of these, a registry based matched cohort study of more than 5000 Japanese CKD5D patients admitted to ICU for more than 3 days, found a higher utilisation of critical care (mechanical ventilation, vasoactive therapy), longer ICU and hospital LoS and higher ICU and 28 day mortality .…”

“…Patients with CKD5D have a higher chance of requiring intensive care support during critical illness . This is perhaps due to complex pre‐existing co‐morbidity and physiological fragility.…”

“…Dialysis-dependent chronic kidney disease (CKD5D) is associated with significant morbidity and mortality, and prevalence is increasing both within Australia and internationally at unprecedented rates. [1][2][3][4][5][6] In 2016 there were 12 706 patients requiring maintenance haemodialysis in Australia, an increase of approximately 30% over the preceding decade. 5 In no other jurisdiction is this increase as conspicuous as in the Northern Territory (NT).…”

Residual Confounding Lurking in Big Data: A Source of Error

“…There have been a plethora of studies in the critical care literature linking renal function to a myriad of outcomes [12,13]. One undisputed conclusion is that impaired renal function is associated with increased cardiovascular mortality, as illustrated in Fig.…”

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

“…Common triggers of cardiopulmonary edema could be represented by pneumonia, excessive inter-dialytic weight gain, inappropriate prescription, but also primary cardiac events [30]. CKD/ESKD is associated with an increased incidence of critical illness and with a greater risk of morbidity and mortality after major surgical procedures [31]. …”