Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study

Abstract

Acute kidney injury (AKI) after severe burns is historically associated with a high mortality. Over the past two decades, various modes of renal replacement therapy (RRT) have been used in this population. The purpose of this multicenter study was to evaluate demographic, treatment, and outcomes data among severe burn patients treated with RRT collectively at various burn centers around the United States. After institutional review board approval, a multicenter observational study was conducted. All adult patients aged 18 or older, admitted with severe burns who were placed on RRT for acute indications but not randomized into a concurrently enrolling interventional trial, were included. Across eight participating burn centers, 171 subjects were enrolled during a 4-year period. Complete data were available in 170 subjects with a mean age of 51 ± 17, percent total body surface area burn of 38 ± 26% and injury severity score of 27 ± 21. Eighty percent of subjects were male and 34% were diagnosed with smoke inhalation injury. The preferred mode of therapy was continuous venovenous hemofiltration at a mean delivered dose of 37 ± 19 (ml/kg/hour) and a treatment duration of 13 ± 24 days. Overall, in hospital, mortality was 50%. Among survivors, 21% required RRT on discharge from the hospital while 9% continued to require RRT 6 months after discharge. This is the first multicenter cohort of burn patients who underwent RRT reported to date. Overall mortality is comparable to other critically ill populations who undergo RRT. Most patients who survive to discharge eventually recover renal function.

Renal Replacement Therapy for Burn Patients: A Systematic Review and Meta-Analysis

“…Among the 58 included studies, 23 were from North America (1, 4, 9, 17-19, 27, 29, 31, 33, 34, 36, 37, 42-44, 48-50, 54, 59, 61, 62), 18 were from Asia (5, 7, 10, 11, 22, 24-26, 28, 39, 40, 46, 47, 51, 52, 58, 64, 66), 15 were from European countries (6, 20, 21, 23, 30, 35, 38, 45, 53, 55-57, 60, 65, 67), one was from South America (32), one was Africa (41). A total of 12 studies could not be used for analysis of the prevalence of RRT, seven of which only reported on RRT patients (11,18,21,37,40,43,45), four of which were RCT studies (9, 10, 51, 52), and the remaining one of which were historical controls (44). Most of the 58 studies (41/60) were retrospective cohort studies, but 12 were prospective cohort studies (7,35,39,41,43,46,47,50,57,58,64,65), and 5 RCT studies (9, 10, 51, 52, 56).…”

“…A recent study found an odds of dialysis of 2.40 in burn patients who developed AKI compared with the general Finnish population (71). Eleven studies followed up the long-term renal outcomes of burn patients who survived RRT (9,18,19,21,27,30,34,36,37,50,54). A total of 184 patients survived after renal replacement therapy; 64.13% of them (118/184) were dialysis-independent after discharge, 25% (46/184) needed temporary required dialysis, and 10.87% (20/184) needed long-term dialysis (more than 6 months after discharge).…”

An unusual presentation of inhalation injury in a patient with high voltage electrical injury: A case report

“…HV and VNOS injuries are associated with renal dysfunction in 13.9% and 4.2% of cases respectively [ 1 ]. Acute kidney injury requiring RRT is associated with 50% mortality in patients with severe burns [ 7 ]. Chung et al appreciated 30% absolute reduction in mortality in burn patients placed on early RRT for acute indications compared to historical controls that were not [ 7 , 8 ].…”

“…Acute kidney injury requiring RRT is associated with 50% mortality in patients with severe burns [ 7 ]. Chung et al appreciated 30% absolute reduction in mortality in burn patients placed on early RRT for acute indications compared to historical controls that were not [ 7 , 8 ]. Furthermore, 90% of survivors experienced renal recovery [ 7 ].…”

“…Chung et al appreciated 30% absolute reduction in mortality in burn patients placed on early RRT for acute indications compared to historical controls that were not [ 7 , 8 ]. Furthermore, 90% of survivors experienced renal recovery [ 7 ]. This suggests potential benefits of early RRT in our patient who developed acute renal failure.…”