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

Abstract

BackgroundPatients 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.MethodsWe 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.ResultsA 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).ConclusionTiming 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.

Lung Ultrasound Score Assessing the Pulmonary Edema in Pediatric Acute Respiratory Distress Syndrome Received Continuous Hemofiltration Therapy: A Prospective Observational Study

“…It is well known that uid overload and AKI were the mainly indications for CRRT intervention in patients with ARDS (29). Our previous multi-center prospective study found that CRRT could signi cantly decrease hospital mortality rate in pediatric ARDS secondary to sepsis (13).…”

Lung ultrasound score assessing the pulmonary edema in pediatric acute respiratory distress syndrome received continuous hemofiltration therapy: A prospective observational study

“…It is well known that uid overload and AKI were the mainly indications for CRRT intervention in patients with ARDS (30). Our previous multi-center prospective study found that CRRT could signi cantly decrease hospital mortality rate in pediatric ARDS secondary to sepsis (16).…”

Lung ultrasound score assessing the pulmonary edema in pediatric acute respiratory distress syndrome received continuous hemofiltration therapy: a prospective observational study

“…It is well known that fluid overload and AKI were the mainly indications for CRRT intervention in patients with ARDS [ 30 ]. Our previous multi-center prospective study found that CRRT could significantly decrease hospital mortality rate in pediatric ARDS secondary to sepsis [ 16 ].…”