Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration

Abstract

BackgroundContinuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significantly high mortality rate. To aid in the management of these high-risk patients, we evaluated the risk factors for mortality in CVVHDF-treated hypotensive AKI patients.MethodsWe studied 67 patients with AKI and hypotension who were treated with CVVHDF from February 2008 to August 2010. We reviewed patient characteristics and laboratory parameters to evaluate the risk factors for 90-day mortality.ResultsOf the 67 enrolled patients (male:female=42:25; mean age=69±14 years), 18 (27%) survived until 90 days after the initiation of CVVHDF. There was no significant difference in survival rates according to the etiology of AKI [hypovolemic shock 2/10 (20%), cardiogenic shock 4/20 (20%), septic shock 12/37 (32%)]. Univariate analysis did show significant differences between survivors and non-survivors in the frequency of ventilator use (44% vs. 76%, respectively; P=0.02), APACHE II score (29±7 vs. 34±7, respectively; P=0.01), SOFA score (11±4 vs. 13±4, respectively; P=0.03), blood pH (7.3±0.1 vs. 7.2±0.1, respectively; P=0.03), and rate of urine output <500 mL for 12 hours (50% vs. 80%, respectively; P=0.03). A multivariate Cox proportional hazards model showed that a urine output<500 mL for 12 hours was the only significant risk factor for 90-day mortality following CVVHDF treatment (odds ratio=2.1, confidence interval=1.01–4.4, P=0.048).ConclusionA urine output<500 mL for 12 hours before the initiation of CVVHDF is an independent risk factor for 90-day mortality in hypotensive AKI patients treated with CVVHDF.

Combined liver‐kidney transplantation for primary hyperoxaluria type I in children: Single Center Experience

“…Yet our first child suffered impaired tissue perfusion associated with hemodialysis that was not related to abnormal cardiac structure or function. Despite being reported to have lesser complications CVVHDF, death complicates 11%‐16% of adult subjects on CVVHDF and hypovolemia/hypotension …”

Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: a multicenter prospective cohort study

“…A more recent investigation of 197 patients requiring CRRT initiation in the ICU setting identified three independent factors associated with fatal outcomes (mechanical ventilation requirement, sepsis, and septic shock requiring vasoactive agents) and two factors associated with favorable outcomes (nonoliguric AKI and low serum creatinine levels). Finally, several study groups have attempted to identify more reliable prognostic factors associated with worse outcomes in patients with AKI, including disease severity assessed according to the APACHE II or SOFA score, amount of urine output, serum BUN level, timing of CRRT, and previous health status [ 3 - 6 , 27 - 29 ]. Despite improvements in the knowledge of such prognostic factors in patients requiring CRRT, the mortality rate of patients with AKI treated with CRRT remains high, reaching nearly 50% [ 30 , 31 ].…”

“…Continuous renal-replacement therapy (CRRT) has become an essential strategy for the management of critically ill patients with acute kidney injury (AKI) [ 1 , 2 ]. Previous research has identified several prognostic factors for mortality—including sepsis, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, oliguria, higher Sequential Organ Failure Assessment (SOFA) score, and the need for mechanical ventilation—in patients with severe AKI undergoing CRRT [ 3 - 6 ]. However, predicting the outcome of patients requiring CRRT remains a challenge.…”

HMG‐CoA reductase inhibitors (statins) and acute kidney injury: A secondary analysis of renal study outcomes

“…The selection of variables was based on identifying all measured clinical variables of known or suspected prognostic importance for mortality. The baseline variables that were assessed included demographic data (age and gender), biochemical (haemoglobin, potassium, creatinine, albumin, pH), clinical (mechanical ventilation, severe sepsis at baseline), urine output), and illness severity scores (Acute Physiology and Chronic Health Evaluation III (APACHE III) score) . A survival curve adjusted for covariates was estimated by the relevant Cox model to compare survival between the statins and non‐statin groups.…”