Intensive Care Medicine

, Volume 33, Issue 5, pp 773–780 | Cite as

Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure

  • Max Bell
  • SWING
  • Fredrik Granath
  • Staffan Schön
  • Anders Ekbom
  • Claes-Roland Martling
Original

Abstract

Objective

Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective was to determine the impact of CRRT and IHD on renal recovery.

Design

Nationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years.

Setting

Thirty-two Swedish intensive care units.

Patients and participants

Eligible subjects were adults treated in Swedish general intensive care units with RRT. A total of 2,642 patients from 32 ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking a diagnosis in the in-patient register (188). Thus, 2,202 patients were studied. Follow-up was complete.

Interventions

None.

Measurements and results

The primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving 90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight patients (8.3%; confidence interval, CI, 6.6–10.2), never recovered their renal function in the CRRT group. The proportion was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0–23.2) developed need for chronic dialysis.

Conclusions

The use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups.

Keywords

Kidney failure, acute Kidney failure, chronic Hemodialysis Intensive care Outcome studies 

Supplementary material

134_2007_590_MOESM1_ESM.xls (25 kb)
Electronic Supplementary Material (XLS 25K)
134_2007_590_MOESM2_ESM.doc (48 kb)
Electronic Supplementary Material (DOC 48K)

References

  1. 1.
    Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818PubMedCrossRefGoogle Scholar
  2. 2.
    Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling CR (2005) Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria. Nephrol Dial Transplant 20:354–360PubMedCrossRefGoogle Scholar
  3. 3.
    Korkeila M, Ruokonen E, Takala J (2000) Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med 26:1824–1831PubMedCrossRefGoogle Scholar
  4. 4.
    Vivino G, Antonelli M, Moro ML, Cottini F, Conti G, Bufi M, Cannata F, Gasparetto A (1998) Risk factors for acute renal failure in trauma patients. Intensive Care Med 24:808–814PubMedCrossRefGoogle Scholar
  5. 5.
    Feest TG, Round A, Hamad S (1993) Incidence of severe acute renal failure in adults: results of a community based study. BMJ 306:481–483PubMedCrossRefGoogle Scholar
  6. 6.
    Liano F, Pascual J (1996) Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 50:811–818PubMedGoogle Scholar
  7. 7.
    Cosentino F, Chaff C, Piedmonte M (1994) Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant 9 Suppl 4:179–182Google Scholar
  8. 8.
    Chertow GM, Christiansen CL, Cleary PD, Munro C, Lazarus JM (1995) Prognostic stratification in critically ill patients with acute renal failure requiring dialysis. Arch Intern Med 155:1505–1511PubMedCrossRefGoogle Scholar
  9. 9.
    Silvester W, Bellomo R, Cole L (2001) Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 29:1910–1915PubMedCrossRefGoogle Scholar
  10. 10.
    Kelleher SP, Robinette JB, Miller F, Conger JD (1987) Effect of hemorrhagic reduction in blood pressure on recovery from acute renal failure. Kidney Int 31:725–730PubMedGoogle Scholar
  11. 11.
    Conger JD, Robinette JB, Hammond WS (1991) Differences in vascular reactivity in models of ischemic acute renal failure. Kidney Int 39:1087–1097PubMedGoogle Scholar
  12. 12.
    Manns M, Sigler MH, Teehan BP (1997) Intradialytic renal haemodynamics—potential consequences for the management of the patient with acute renal failure. Nephrol Dial Transplant 12:870–872PubMedCrossRefGoogle Scholar
  13. 13.
    Manns B, Doig CJ, Lee H, Dean S, Tonelli M, Johnson D, Donaldson C (2003) Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med 31:449–455PubMedCrossRefGoogle Scholar
  14. 14.
    Blomqvist P, Ekbom A, Nyren O, Krusemo UB, Bergstrom R, Adami HO (1999) Survival after rectal cancer: differences between hospital catchment areas. A nationwide study in Sweden. Gut 45:39–44PubMedCrossRefGoogle Scholar
  15. 15.
    Nyren O, McLaughlin JK, Gridley G, Ekbom A, Johnell O, Fraumeni JF Jr., Adami HO (1995) Cancer risk after hip replacement with metal implants: a population-based cohort study in Sweden. J Natl Cancer Inst 87:28–33PubMedCrossRefGoogle Scholar
  16. 16.
    Schon S, Ekberg H, Wikstrom B, Oden A, Ahlmen J (2004) Renal replacement therapy in Sweden. Scand J Urol Nephrol 38:332–339PubMedCrossRefGoogle Scholar
  17. 17.
    Lunde AS, Lundeborg S, Lettenstrom GS, Thygesen L, Huebner J (1980) The person-number systems of Sweden, Norway, Denmark, and Israel. Vital Health Stat 2 2:1–59Google Scholar
  18. 18.
    Serden L, Lindqvist R, Rosen M (2005) [Benefits with well-educated medical secretaries. Improved coding in the patient registry following a course in classification and care documentation]. Lakartidningen 102:1530, 1533–1534, 1536–1537PubMedGoogle Scholar
  19. 19.
    Anderson WN (2000) Algorithms for actuarial and actual analysis. Proceedings of 8th Annual Western Users of SAS Software (WUSS):128–133Google Scholar
  20. 20.
    SAS/STAT® version 9.1. SAS Institute Inc, Cary, NCGoogle Scholar
  21. 21.
    Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, Pallot JL, Chiche JD, Taupin P, Landais P, Dhainaut JF (2006) Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 368:379–385PubMedCrossRefGoogle Scholar
  22. 22.
    Kellum JA, Angus DC, Johnson JP, Leblanc M, Griffin M, Ramakrishnan N, Linde-Zwirble WT (2002) Continuous versus intermittent renal replacement therapy: a meta-analysis. Intensive Care Med 28:29–37PubMedCrossRefGoogle Scholar
  23. 23.
    Tonelli M, Manns B, Feller-Kopman D (2002) Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery. Am J Kidney Dis 40:875–885PubMedCrossRefGoogle Scholar
  24. 24.
    Mehta RL, McDonald B, Gabbai FB, Pahl M, Pascual MT, Farkas A, Kaplan RM (2001) A randomized clinical trial of continuous versus intermittent dialysis for acute renal failure. Kidney Int 60:1154–1163PubMedCrossRefGoogle Scholar
  25. 25.
    Jacka MJ, Ivancinova X, Gibney RT (2005) Continuous renal replacement therapy improves renal recovery from acute renal failure. Can J Anaesth 52:327–332PubMedGoogle Scholar
  26. 26.
    Schiffl H (2006) Renal recovery from acute tubular necrosis requiring renal replacement therapy: a prospective study in critically ill patients. Nephrol Dial Transplant 21:1248–1252PubMedCrossRefGoogle Scholar
  27. 27.
    Augustine JJ, Sandy D, Seifert TH, Paganini EP (2004) A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 44:1000–1007PubMedCrossRefGoogle Scholar
  28. 28.
    Van der Schueren G, Diltoer M, Laureys M, Huyghens L (1996) Intermittent hemodialysis in critically ill patients with multiple organ dysfunction syndrome is associated with intestinal intramucosal acidosis. Intensive Care Med 22:747–751PubMedCrossRefGoogle Scholar
  29. 29.
    Davenport A, Will EJ, Davidson AM (1993) Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med 21:328–338PubMedCrossRefGoogle Scholar
  30. 30.
    Lameire N, Van Biesen W, Vanholder R, Colardijn F (1998) The place of intermittent hemodialysis in the treatment of acute renal failure in the ICU patient. Kidney Int Suppl 66:S110–119PubMedGoogle Scholar
  31. 31.
    Abdeen O, Mehta RL (2002) Dialysis modalities in the intensive care unit. Crit Care Clin 18:223–247PubMedCrossRefGoogle Scholar
  32. 32.
    van Bommel EF, Ponssen HH (1997) Intermittent versus continuous treatment for acute renal failure: where do we stand? Am J Kidney Dis 30:S72–79PubMedGoogle Scholar
  33. 33.
    Gokal R (1993) Quality of life in patients undergoing renal replacement therapy. Kidney Int Suppl 40:S23–27PubMedGoogle Scholar
  34. 34.
    De Wit GA, Ramsteijn PG, de Charro FT (1998) Economic evaluation of end stage renal disease treatment. Health Policy 44:215–232PubMedCrossRefGoogle Scholar
  35. 35.
    Churchill DN, Torrance GW, Taylor DW, Barnes CC, Ludwin D, Shimizu A, Smith EK (1987) Measurement of quality of life in end-stage renal disease: the time trade-off approach. Clin Invest Med 10:14–20PubMedGoogle Scholar
  36. 36.
    Gorodetskaya I, Zenios S, McCulloch CE, Bostrom A, Hsu CY, Bindman AB, Go AS, Chertow GM (2005) Health-related quality of life and estimates of utility in chronic kidney disease. Kidney Int 68:2801–2808PubMedCrossRefGoogle Scholar
  37. 37.
    Lee H, Manns B, Taub K, Ghali WA, Dean S, Johnson D, Donaldson C (2002) Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access. Am J Kidney Dis 40:611–622PubMedCrossRefGoogle Scholar
  38. 38.
    Manns BJ, Taub KJ, Donaldson C (2000) Economic evaluation and end-stage renal disease: from basics to bedside. Am J Kidney Dis 36:12–28PubMedGoogle Scholar
  39. 39.
    Hamel MB, Phillips RS, Davis RB, Desbiens N, Connors AF Jr., Teno JM, Wenger N, Lynn J, Wu AW, Fulkerson W, Tsevat J (1997) Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med 127:195–202PubMedGoogle Scholar
  40. 40.
    SRAU (2005) Renal replacement therapy in Sweden 1991–2004 [in Swedish]. Svenskt Register för Aktiv UremivårdGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Max Bell
    • 1
  • SWING
    • 2
  • Fredrik Granath
    • 3
  • Staffan Schön
    • 4
  • Anders Ekbom
    • 3
  • Claes-Roland Martling
    • 1
  1. 1.Department of Anaesthesiology and Intensive CareKarolinska University HospitalSolnaSweden
  2. 2.SWING is the Swedish Intensive care Nephrology Group, whose member hospitals are tabulated in the appendixesn.a.Sweden
  3. 3.Department of Medicine, Clinical Epidemiology UnitKarolinska University HospitalSolnaSweden
  4. 4.Swedish Register of Active Treatment of Uraemia, Department of NephrologyKärnhospitalSkövdeSweden

Personalised recommendations