Mortality predictors in critically ill patients with acute kidney injury requiring continuous renal replacement therapy

Medina-Liabres, Kristianne Rachel P.; Jeong, Jong Cheol; Oh, Hyung Jung; An, Jung Nam; Lee, Jung Pyo; Kim, Yon Su; Ryu, Dong Ryeol; Kim, Sejoong

doi:10.23876/j.krcp.20.205

Cited by 18 publications

(15 citation statements)

References 29 publications

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“…Moreover, volume overload was an independent risk factor for mortality in our study. Our results are consistent with those of a previous study that reported that volume overload increases the risk of AKI and mortality, independent of the severity of acute illness, indicating that prevention of volume overload is crucial in managing critically ill patients [ 24 ]. We stratified high-volume fluid therapy and bicarbonate therapy using RERI analysis, and each variable independently and synergistically had detrimental effects on the development of AKI.…”

Section: Discussionsupporting

confidence: 93%

Role of bicarbonate and volume therapy in the prevention of acute kidney injury in rhabdomyolysis: a retrospective propensity score-matched cohort study

Kim¹,

Kim

Ohn

et al. 2022

Kidney Res Clin Pract

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Background: Although bicarbonate has traditionally been used to treat patients with rhabdomyolysis at high risk of acute kidney injury (AKI), it is unclear whether this is beneficial. This study compared bicarbonate therapy to non-bicarbonate therapy for the prevention of AKI and mortality in rhabdomyolysis patients. Methods: In a propensity score-matched cohort study, patients with a creatine kinase (CK) level of >1,000 U/L during hospitalization were divided into bicarbonate and non-bicarbonate groups. Patients were subgrouped based on low-volume (<3 mL/kg/hr) or high-volume (≥3 mL/kg/hr) fluid resuscitation in the first 72 hours. Logistic regression analyses were used to identify the impacts of bicarbonate use and fluid resuscitation on AKI risk and need for dialysis. The Kaplan-Meier method was used to estimate survival. Volume overload and electrolyte imbalances were assessed. Results: Among 4,077 patients, we assembled a cohort of 887 pairs of patients treated with and without bicarbonate. Bicarbonate group had a higher incidence of AKI, higher rate of dialysis dependency, higher 30-day mortality, and longer hospital stay than the non-bicarbonate group. Further, patients who received high-volume fluid therapy had worse renal outcomes and a higher mortality than those who received low-volume fluids regardless of bicarbonate use. Bicarbonate use, volume overload, and AKI were associated with higher mortality. Volume overload was significantly higher in the bicarbonate group than in the non-bicarbonate group. Conclusion: Bicarbonate or high-volume fluid therapy for patients with rhabdomyolysis did not reduce AKI or improve mortality compared to non-bicarbonate or low-volume fluid therapy. Limited use of bicarbonate and adjustment of fluid volume may improve the short-and long-term outcomes of patients with rhabdomyolysis.

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Section: Discussionsupporting

confidence: 93%

Role of bicarbonate and volume therapy in the prevention of acute kidney injury in rhabdomyolysis: a retrospective propensity score-matched cohort study

Kim¹,

Kim

Ohn

et al. 2022

Kidney Res Clin Pract

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“…Regarding mechanical ventilation use in patients receiving RRT, our finding is similar to other reported data, finding that it is frequently required in this category of patients [19]. Along the same lines, the reported use of vasopressor therapy varies from 62.1% to 100% of cases [17,25]. In the present study, we described a significant association between the need of vasopressor requirement and RRT use.…”

Section: Discussionsupporting

confidence: 91%

“…Although there are limited data about the costs related to RRT use in critically ill patients [17], in association with important mortality and morbidity, identifying patients with higher odds of benefitting after such intervention may be of great value for the improvement of medical decisions. Therefore, population-based studies regarding RRT use in the general critical care population are useful in understanding the trend and impact of medical care interventions.…”

Section: Introductionmentioning

confidence: 99%

Overview of Renal Replacement Therapy Use in a General Intensive Care Unit

Ţigliş

Peride

Florea

et al. 2022

IJERPH

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Objectives. Population-based studies regarding renal replacement therapy (RRT) used in critical care populations are useful to understand the trend and impact of medical care interventions. We describe the use of RRT and associated outcomes (mortality and length of intensive care stay) in a level 1 hospital. Design. A retrospective descriptive observational study. Patients. Critically ill patients admitted to the ICU from 1 January to 31 December 2018. Interventions. Age, gender, ward of admission, primary organ dysfunction at admission, length of hospital stay (LOS), mechanical ventilation, APACHE, SOFA and ISS scores, the use of vasopressors, transfusion, RRT and the number of RRT sessions were extracted. Results. 1703 critically ill patients were divided into two groups: the RRT-group (238 patients) and the non-RRT group (1465 patients). The mean age was 63.58 ± 17.52 (SD) in the final ICU studied patients (64.72 ± 16.64 SD in the RRT-group), 60.5% being male. Patients admitted from general surgery ward needing RRT were 41.4%. The specific scores, the use of vasopressors, transfusions and mortality were higher in the RRT-group. The ICU LOS was superior in the RRT-group, regardless of the primary organ dysfunction. Conclusions. RRT was practiced in 13.9% of patients (especially after age of 61), with mortality being the outcome for 66.8% of the RRT-group patients. All analyzed data were higher in the RRT group, especially for multiple trauma and surgical patients, or patients presenting cardiac or renal dysfunctions at admission. We found significant increased ISS scores in the RRT-group, a significant association between the need of vasopressors or transfusion requirement and RRT use, and an association in the number of RRT sessions and LOS (p < 0.001).

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“… 12 , 13 Several clinical characteristics predicted mortality in CRRT patients. 12 - 14 Among these factors is the derangement of various electrolytes reported to be associated with higher mortality in CRRT patients. 15 - 18 Although serum phosphate derangement has been associated with increased mortality risk in various study populations such as hospitalized individuals, particularly critically ill and septic patients, 5 , 7 , 19 - 24 there is limited evidence on whether serum phosphate is associated with mortality or has any predictive value in critically ill AKI patients receiving CRRT.…”

Section: Introductionmentioning

confidence: 99%

Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy

Radhakrishnan

Cheungpasitporn

Petnak

et al. 2022

Can J Kidney Health Dis

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Background: There is limited evidence on the association of serum phosphate with mortality in patients receiving continuous renal replacement therapy (CRRT). Objective: To assess the association of serum phosphate with mortality in critically ill patients requiring CRRT for acute kidney injury (AKI). Design: A cohort study. Setting: A tertiary referral hospital in the United States. Patients: Acute kidney injury patients receiving CRRT from 2006 through 2015 in intensive care units. Measurements: (1) Serum phosphate before CRRT and (2) mean serum phosphate during CRRT were categorized into 3 groups; ≤2.4 (hypophosphatemia), 2.5 to 4.5 (normal serum phosphate group), and ≥4.6 (hyperphosphatemia) mg/dL. Methods: Multivariable logistic regression was used to assess the association between serum phosphate and 90-day mortality. Results: A total of 1108 patients were included in this study. Of these, 55% died within 90 days after CRRT initiation. Before CRRT, 3%, 30%, and 66% had hypophosphatemia, normophosphatemia, and hyperphosphatemia, respectively. Before CRRT, both hypophosphatemia and hyperphosphatemia were significantly associated with higher 90-day mortality with the adjusted odds ratio (OR) of 2.22 (95% confidence interval [CI]: [1.03, 4.78]) and 1.62 (95% CI: [1.21, 2.18]), respectively. During CRRT, 3%, 85%, and 12% had mean serum phosphate in hypophosphatemia, normophosphatemia, and hyperphosphatemia range. During CRRT, hyperphosphatemia was significantly associated with higher 90-day mortality with adjusted OR of 2.22 (95% CI: [1.45, 3.38]). Limitations: Single center, observational design, lack of information regarding causes of serum phosphate derangement. Conclusion: Most CRRT patients had hyperphosphatemia before CRRT initiation but maintain normal serum phosphate during CRRT. Before CRRT, hypo- and hyperphosphatemia, and during CRRT, hyperphosphatemia predicted higher mortality. Trial registration: Not registered.

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Mortality predictors in critically ill patients with acute kidney injury requiring continuous renal replacement therapy

Cited by 18 publications

References 29 publications

Role of bicarbonate and volume therapy in the prevention of acute kidney injury in rhabdomyolysis: a retrospective propensity score-matched cohort study

Role of bicarbonate and volume therapy in the prevention of acute kidney injury in rhabdomyolysis: a retrospective propensity score-matched cohort study

Overview of Renal Replacement Therapy Use in a General Intensive Care Unit

Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy

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