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Acute renal replacement therapy in critically ill octogenarian or older patients: prognostic factors and renal outcomes

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Abstract

Background

The number of octogenarians or older patients admitted to the intensive care unit (ICU) has been growing over the past several years. The aim of this study is to assess factors associated with acute renal replacement therapy (ARRT) requirement in these patients and the impact of this therapy on 90-day mortality. We also aimed to identify prognostic factors associated with mortality risk in the group of patients that required ARRT.

Methods

Retrospective study of octogenarian or older patients admitted to the ICU at Hospital Clínic de Barcelona from June 2007 to April 2019. Patients on chronic dialysis treatment or with a kidney transplant, and patients with limitation of therapeutic support or admitted for less than 48 h were excluded.

Results

217 patients were included in the study, of whom 36.4% required ARRT. Use of vasoactive drugs (VAD) and Sequential Organ Failure Assessment (SOFA) score on admission were higher in ARRT patients (P = 0.009 and < 0.001, respectively). Basal estimated glomerular filtration rate (eGFR) was lower in the ARRT cohort (P < 0.001). Hospital and ICU length of stay were longer in the ARRT cohort (P < 0.001). Ninety-day mortality was 58.2% in the ARRT cohort compared to 55.8% in the non-ARRT control cohort (P = NS). In the survival analysis, only female sex, sepsis and non-renal SOFA ≥ 6.5 were significantly associated with mortality (P = 0.002, 0.028 and 0.009, respectively) in the ARRT cohort.

Conclusion

Mortality was not significantly increased in the octogenarian or older population that required and received ARRT compared to control patients who did not require it. Severity scores like SOFA could help in the process of decision making about initiation of ARRT in this population.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

Hospital Clínic Intensive Care Working Group (GTMC, Grup de Treball del Malalt Crític): Sara Fernández, Josep Maria Nicolàs, Pedro Castro, Intensive Care Unit, Internal Medicine Department, Hospital Clínic, IDIBAPS, Rut Andrea, Oriol de Diego, José Tomás Ortiz, Acute Cardiac Care, Cardiology Department, Hospital Clínic, IDIBAPS, Enric Reverter, Javier Fernández, David Toapanta, Intensive Care Unit, Hepatology Department, Hospital Clínic, IDIBAPS, Jordi Mercadal, Carlos Ferrando, Xavier Borrat, Surgical ICU, Anesthesiology Department, Hospital Clínic, IDIBAPS, Antoni Torres, Joan Ramón Badia, Miquel Ferrer, Intensive Care Unit, Pneumology Department, Hospital Clínic, IDIBAPS, Eduard Quintana, Daniel Pereda, Elena Sandoval, Irene Rovira, Intensive care unit, Cardiovascular-Surgery Department, Hospital Clínic, IDIBAPS.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

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Authors and Affiliations

  1. Nephrology and Kidney Transplantation Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Alícia Molina-Andújar, Joaquim Casals, Jimena Del Risco-Zevallos, Evelyn Hermida, Luis F. Quintana, Miquel Blasco, Gaston Piñeiro & Esteban Poch

Authors
  1. Alícia Molina-Andújar
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  2. Joaquim Casals
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  3. Jimena Del Risco-Zevallos
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  4. Evelyn Hermida
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  5. Luis F. Quintana
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  6. Miquel Blasco
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  7. Gaston Piñeiro
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  8. Esteban Poch
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Consortia

The Hospital Clínic Intensive Care Working Group (GTMC).

Contributions

AMA conceived and designed the study. Material preparation, data collection and analysis were performed by AMA, JC and JDR. The first draft of the manuscript was written by AMA and supervised by GP and EP. EH, LFQ, MB, GP and EP interpreted the data, revised the manuscript, provided intellectual content and approved the final version.

Corresponding authors

Correspondence to Alícia Molina-Andújar or Esteban Poch.

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Conflict of interest

The authors declare that there are no conflicts of interest.

Ethics approval

The study was approved by the ethics committee of the Hospital Clínic de Barcelona (Reg. HCB/2020/1083). Because of the characteristics of the study patients were not able to sign informed consent.

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Molina-Andújar, A., Casals, J., Del Risco-Zevallos, J. et al. Acute renal replacement therapy in critically ill octogenarian or older patients: prognostic factors and renal outcomes. J Nephrol 34, 1531–1536 (2021). https://doi.org/10.1007/s40620-021-01034-w

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  • DOI: https://doi.org/10.1007/s40620-021-01034-w

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