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Renal replacement therapy in the ICU: comparison of clinical features and outcomes of patients with acute kidney injury and dialysis-dependent end-stage renal disease

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Summary

Background

The goal of this study is to study clinical features and outcomes of the patients who had renal replacement therapy (RRT) in the intensive care unit (ICU) between 2000 and 2007.

Methods

We retrospectively studied 222 patients.

Results

Overall ICU mortality and invasive mechanical ventilation (IMV) rates were 58.1 and 61.3 %. The mean APACHE II score was 27.6 ± 8.3. Chronic dialysis (CD) patients formed 45.5 % of the study population. Acute kidney injury (AKI) patients had higher rates of IMV (73 vs. 51.5 %, p = 0.002), cancer (27.8 vs. 7.9 %, p ≤ 0.001) and mortality (67.8 vs. 50.5 %, p = 0.010) than CD patients. AKI patients with normal kidney function (NKF) before ICU admission had poorer prognosis than acute-on-chronic kidney disease (CKD) and CD patients (78.6, 51 and 50.5 %, respectively, p ≤ 0.001). Multivariate analysis showed that IMV (OR, 14.8; 95 % CI, 5.47–40.05; p ≤ 0.001) and having NKF before hospitalization (OR, 2.8; 95 % CI, 1.04–7.37; p = 0.041) were predictors of overall ICU mortality. Additionally, IMV is found as a prognostic factor for both AKI (OR, 18.7; 95 % CI, 4.48–77.72; p ≤ 0.001) and CD patients (OR, 8.14; 95 % CI, 2.01–33.04; p = 0.003), but APACHE II score is meaningful only for CD patients (OR, 1.13; 95 % CI, 1.02–1.26; p = 0.024). The areas under the ROC curves for APACHE II score were 0.52 (95 % CI, 0.39–0.66) for AKI and 0.78 (95 % CI, 0.55–0.89) for CD patients.

Conclusion

The observed ICU mortality among patients requiring RRT is high and IMV is associated with mortality. AKI patients have increased mortality compared to CD patients. AKI patients with past NKF have poorer prognosis than acute-on-CKD and CD patients.

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References

  1. Strijack B, Mojica J, Sood M, et al. Outcomes of chronic dialysis patients admitted to the intensive care unit. J Am Soc Nephrol. 2009;20:2441–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Metnitz PGH, Moreno RP, Almeida E, et al. SAPS 3—from evaluation of the patient to evaluation of the intensive care unit. Part 1: objectives, methods and cohort description. Intensive Care Med. 2005;31:1336–44.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Uchino S, Morimatsu H, Bellomo R, Silvester W, Cole L. End-stage renal failure patients requiring renal replacement therapy in the intensive care unit: incidence, clinical features, and outcome. Blood Purif. 2003;21:170–5.

    Article  PubMed  Google Scholar 

  4. Hutchison CA, Crowe AV, Stevens PE, Harrison DA, Lipkin GW. Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care. 2007;11:R50.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Dara SI, Bekele A, Bajwa AA, Albright RC. Outcome of patients with end-stage renal disease admitted to the intensive care unit. Mayo Clin Proc. 2004;79:1385–90.

    Article  PubMed  Google Scholar 

  6. Manhes G, Heng AE, Aublet-Cuvelier B, Gazuy N, Deteix P, Souweine B. Clinical features and outcome of chronic dialysis patients admitted to an intensive care unit. Nephrol Dial Transplant. 2005;20:1127–33.

    Article  PubMed  Google Scholar 

  7. Rocha E, Soares M, Valente C, et al. Outcomes of critically ill patients with acute kidney injury and end-stage renal disease requiring renal replacement therapy: a case-control study. Nephrol Dial Transplant. 2009;24:1924–30.

    Google Scholar 

  8. Clermont G, Acker CG, Angus DC, Sirio CA, Pinsky MR, Johnson JP. Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int. 2002;62:986–96.

    Article  PubMed  Google Scholar 

  9. Chapman RJ, Templeton M, Ashworth S, Broomhead R, McLean A, Brett SJ. Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure. Crit Care. 2009;13:R65.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Allegretti AS, Steele DJ, David-Kasdan JA, Bajwa E, Niles JL, Bhan I. Continuous renal replacement therapy outcomes in acute kidney injury and end stage renal disease: a cohort study. Crit Care. 2013;17:R109.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.

    Article  CAS  PubMed  Google Scholar 

  12. De Mendonça A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–21.

    Article  PubMed  Google Scholar 

  13. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104:343–8.

    Article  CAS  PubMed  Google Scholar 

  14. Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM. The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis. 2005;46:1038–48.

    Article  PubMed  Google Scholar 

  15. Avasthi G, Sandhu JS, Mohindra K. Acute renal failure in medical and surgical intensive care units—a one year prospective study. Ren Fail. 2003;25:105–13.

    Article  PubMed  Google Scholar 

  16. Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int. 2005;67:2089–100.

    Article  PubMed  Google Scholar 

  17. Van Steen K, Curran D, Kramer J, et al. Multicollinearity in prognostic factor analyses using the EORTC QLQ-C30: identification and impact on model selection. Statist Med. 2002;21:3865–84.

    Article  Google Scholar 

  18. Walcher A, Faubel S, Keniston A, Dennen P. In critically ill patients requiring CRRT, AKI is associated with increased respiratory failure and death versus ESRD. Ren Fail. 2011;33:935–42.

    Article  PubMed  Google Scholar 

  19. Ostermann M, Chang R. Renal failure in the intensive care unit: acute kidney injury compared to end-stage renal failure. Crit Care. 2008;12:432–3.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Bagshaw SM, Mortis G, Doing CJ, Godinez-Luna T, Fick GH, Laupland KB. One-year mortality in critically ill patients by severity of kidney dysfunction: a population-based assessment. Am J Kidney Dis. 2006;48:402–9.

    Article  PubMed  Google Scholar 

  21. Steinvall I, Bak Z, Sjoberg F. Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study. Crit Care. 2008;12:R124.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Senthuran S, Bandeshe H, Ranganathan D, Boots R. Outcomes for dialysis patients with end-stage renal failure admitted to an intensive care unit or high dependency unit. Med J Aust. 2008;188:292–5.

    PubMed  Google Scholar 

  23. Juneja D, Prabhu MV, Gopal PB, Mohan S, Spridhar G, Nayak KS. Outcome of patients with end stage renal disease admitted to an intensive care unit in India. Ren Fail. 2010;32:69–73.

    Article  PubMed  Google Scholar 

  24. Sood MM, Miller L, Komenda P, et al. Long-term outcomes of end-stage renal disease patients admitted to the ICU. Nephrol Dial Transplant. 2011;26:2965–70.

    Article  PubMed  Google Scholar 

  25. Arulkumaran N, Annear NMP, Singer M. Patients with end-stage renal disease admitted to the intensive care unit: systematic review. Br J Anaesth. 2013;110:13–20.

    Article  CAS  PubMed  Google Scholar 

  26. Libório AB, Abreu KL, Silva GB Jr, et al. Predicting hospital mortality in critically ill cancer patients according to acute kidney injury severity. Oncology. 2011;80:160–6.

    Article  PubMed  Google Scholar 

  27. Soares M, Salluh JI, Carvalho MS, Darmon M, Rocco JR, Spector N. Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol. 2006;24:4003–10.

    Article  PubMed  Google Scholar 

  28. Maccariello E, Valente C, Nogueira L, et al. Outcomes of cancer and non-cancer patients with kidney injury and need of renal replacement therapy admitted to general intensive care units. Nephrol Dial Transplant. 2011;26:537–43.

    Article  PubMed  Google Scholar 

  29. De Carvalho JR, Villela-Nogueira CA, Luiz RR, et al. Acute kidney injury network criteria as a predictor of hospital mortality in cirrhotic patients with ascites. J Clin Gastroenterol. 2012;46:e21–6.

    Article  PubMed  Google Scholar 

  30. Cholongitas E, Senzolo M, Patch D, Shaw S, O’Beirne J, Burroughs AK. Cirrhotics admitted to intensive care unit: the impact of acute renal failure on mortality. Eur J Gastroenterol Hepatol. 2009;21:744–50.

    Article  PubMed  Google Scholar 

  31. Fraley DS, Burr R, Bernardini J, Angus D, Kramer DJ, Johnson JP. Impact of acute renal failure on mortality in end-stage liver disease with or without transplantation. Kidney Int. 1998;54:518–24.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Dr. Pınar Ay, M.D., Assoc. Prof. of Health Care and Statistic at Marmara University, School of Medicine, for his help with the statistical analysis. T. Akbaş designed the study, gathered the raw data of the study and contributed to the writing of the paper. Sait Karakurt helped the study design, reviewed the paper and contributed to the writing of the manuscript. Serhan Tuğlular designed the study, reviewed the paper and contributed to the writing of the manuscript. All authors read, edited and ultimately approved the final manuscript.

Conflict of interest

All authors have declared that no conflict of interest exists.

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Authors and Affiliations

  1. Department of Internal Medicine and Critical Care Unit, School of Medicine, Marmara University, Istanbul, Turkey

    Türkay Akbaş

  2. Department of Pulmonary and Critical Care Medicine, School of Medicine, Marmara University, Istanbul, Turkey

    Sait Karakurt

  3. Department of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey

    Serhan Tuğlular

  4. Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi, No:41 Üst Kaynarca, Pendik, Istanbul, 34899, Turkey

    Türkay Akbaş

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  1. Türkay Akbaş
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Correspondence to Türkay Akbaş.

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Akbaş, T., Karakurt, S. & Tuğlular, S. Renal replacement therapy in the ICU: comparison of clinical features and outcomes of patients with acute kidney injury and dialysis-dependent end-stage renal disease. Clin Exp Nephrol 19, 701–709 (2015). https://doi.org/10.1007/s10157-014-1028-4

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  • DOI: https://doi.org/10.1007/s10157-014-1028-4

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